How do patients with severe mental diagnosis cope in everyday life - a qualitative study comparing patients’ experiences of self-referral inpatient treatment with treatment as usual?

Abstract

BackgroundSeveral hospitals in Norway provide short self-referral inpatient treatment to patients with severe mental diagnosis. No studies have compared the experiences of patients who have had the opportunity to self-refer to inpatient treatment with patients who have received treatment as usual. This qualitative study was nested within a randomised controlled trial investigating the effect of self-referral to inpatient treatment. The aim was to explore how patients with severe mental diagnosis coped four months after signing a contract for self-referral, as compared to patients receiving treatment as usual.MethodsData was collected using qualitative individual interviews with patients with severe mental diagnosis, conducted four months after being randomised either to a contract for self-referral (intervention group) or to treatment as usual (control group).ResultsTwenty-five patients participated in interviews - 11 from the intervention group and 14 from the control group. Results four months after randomisation showed that patients with a contract for self-referral appeared to have more confidence in strategies to cope with mental illness and to apply more active cognitive strategies. Patients with a contract also expressed less resignation, hopelessness and powerlessness than patients without a contract. In addition, patients with a contract seemed to be closer to the ideal of living a "normal" life and being a "normal" person.ConclusionThe results indicate that the patients who had a contract for self-referral had come further in the recovery process and should possibly be better off during treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-347) contains supplementary material, which is available to authorized users.

Feeling safe with patient‐controlled admissions: A grounded theory study of the mental health patients' experiences

“…We therefore assess that our illustrative model and the established main concern about feeling safe and the circumstances that could affect this are essential when discussing the PCA programme. The concern for feeling safe is in line with what other studies have found (Olsø et al., 2016; Rise et al., 2014; Strand et al., 2017; Tytlandsvik & Heskestad, 2009) and may point to the fact that safety is particularly important for patients with a mental disorder, regardless of diagnosis. Studies regarding patient preferences during crisis also report that an available safe environment (Gudde et al., 2013) and being able to feel safe are important and helpful components (Klevan et al., 2017; Winness et al., 2010).…”

“…Two other studies found that patients value the possibility to forestall the need for prolonged hospitalisations (Olsø et al., 2016; Strand et al., 2017). Patients also perceived that the health service differed substantially from earlier experiences of inpatient care (Olsø et al., 2016; Rise et al., 2014). The direct access to an inpatient admission, without going through the traditional admission procedure seemed to enhance patients’ confidence, and patients with a contract appeared to have a wider range of coping strategies than patients without a PCA contract (Rise et al., 2014).…”

Self‐admission to inpatient treatment for patients with anorexia nervosa: The patient's perspective

“…Whereas previous qualitative studies (Olsø et al, ; Rise et al, ) of patients with a psychotic or bipolar disorder who had been provided with a contract for self‐admission reported only positive effects of the model, such as a broader repertoire of coping strategies and diminished feelings of resignation, in the present study there were also obstacles associated with the model that could hinder a constructive use of self‐admission in AN patients. A major obstacle was participants’ ambivalence in asking for help.…”

“…Participants highlighted how self‐admission served as a safety‐valve, transforming the inpatient ward into a safe haven for them (Olsø et al, ). Patients with a contract for self‐admission displayed greater confidence in using coping strategies to deal with their illness and a broader repertoire of cognitive tools (Rise et al, ). Furthermore, they expressed a stronger tendency of using these skills “in order to grow, to break barriers and to take opportunities” (Rise et al, , p. 5).…”

Re‐establishing and preserving hope of recovery through user participation in patients with a severe mental disorder: the self‐referral‐to‐inpatient‐treatment project

“…As a reaction to this, in addition to new governmental guidelines and the fact that randomized clinical trials were missing, the SRIT project was given to CMHC. One qualitative study from the project has compared the experiences of self‐referral inpatient treatment with treatment as usual (Rise et al., ). The result from 4 months after randomization indicates that patients with a contract for SRIT had come further in the recovery process.…”