The development of care and prevention model for relapses in psychiatric and substance abuse patients who are high risk of violence, Charoensin District, Sakon Nakhon Province.

Abstract

      This participatory action research aimed to develop a model for the care and relapse prevention of patients with severe mental illness and substance use disorders who are at high risk of violence (SMI-V). The study was conducted in Nong Paen Subdistrict, Charoen Sin District, Sakon Nakhon Province, from October 2025 to March 2026. The sample consisted of 53 psychiatric and substance abuse network partners, 10 primary caregivers, and 10 SMI-V patients. Research instruments included questionnaires, focus group discussion guidelines, violence risk assessment form, violence recording form, knowledge test, and a satisfaction assessment scale. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using descriptive statistics and a paired t-test.

      The results showed; The identified challenges included patient non-adherence to medication and substance abuse relapse, caregivers’ lack of knowledge and surveillance skills, fragmented community-based care, inadequate post-discharge follow-up, and environmental triggers within the community. The developed model, titled "The Tripartite Model for Community Safety," comprises three key components: medical personnel, community networks, and community crisis response teams. The model involves four systematic steps: (1) database development, (2) proactive surveillance, (3) healthcare system management, and (4) continuous follow-up. Findings indicated that after the intervention, the network partners’ knowledge scores significantly increased (t=-10.206, p<0.001), and the patients' violence risk scores significantly decreased (t=8.430, p<0.001). No incidents of violence or readmissions were reported during the study period. Furthermore, the overall satisfaction with the model was at the highest level (=4.46, S.D.=0.56).