Brief user-controlled admission (BUCA) in psychiatric care

Brief User-Controlled Admission (BUCA) refers to a set of crisis interventions in which the traditional gatekeeping role of the physician is bypassed, allowing service users to independently decide when to access short-term inpatient care through a pre-negotiated agreement. Examples include Brief Admission by self-referral, Patient-Initiated Brief Admission, Patient-Controlled Admission, and Self-Referral to Inpatient Treatment. The structured agreement promotes predictability and collaboration, enabling the user to assume control over their care. BUCA has been studied in adults and adolescents with severe mental distress at risk for escalation of symptoms, self-harm or suicide. Users report high satisfaction, describing the agreement as a source of psychological safety, dignity, and proactive crisis management. Staff experience strengthened therapeutic alliances and role shifts from gatekeeping to collaboration. Families experience relief, though they may need information and support adapting to the user-led structure. BUCA has been associated with increased functioning in daily life, and lower healthcare costs, particularly among users with high service utilization. While earlier studies have suggested potential reductions in inpatient care, studies including controls have not proven significant effects. Representing a shift towards user-led care, BUCA offers a scalable and potentially cost-effective model aligned with current mental health reform priorities.