Medication-free treatment in mental health care: How does it differ from traditional treatment?

Abstract

Background Norwegian health authorities have implemented treatment units devoted to medication-free mental health treatment in all health regions to improve people’s freedom of choice. This article examines how medication-free treatment differs from treatment as usual across various central dimensions. Methods We used a mixed-methods design that included questionnaire data obtained from a medication-free unit and two comparison units (n 59 + 124), as well as interviews with patients (n 5) and staff (n 8) in the medication-free unit. Participants compared their experiences with the unit to other relevant experiences with mental health care. Results Medication-free treatment involved less reliance on medications to become well and more extensive psychosocial treatment that involved a culture of openness, expression of feelings, and focus on individual responsibility and intensive work. The extent of formal examination and overall ratings of help with medications was similar to that in standard treatment. Medication-free treatment was experienced as more demanding. For patients, this could be connected to a stronger sense of purpose and was experienced as helpful but could also be experienced as a type of pressure and lack of understanding. The extent of patient influence for medication-free treatment compared with standard treatment varied on different themes, but the overall measures related to patient influence were similar between medication-free and standard treatment. Patients in medication-free treatment had more freedom to reduce or not use medication. Other changes went in different directions. Patients in medication-free treatment reported greater satisfaction with the treatment, which may be linked to a richer psychosocial treatment package that focuses on patient participation and freedom from pressure to use medication. Conclusion The findings provide insights into how a medication-free treatment service might work and show that it can be a viable alternative for people who are not comfortable with the current medication focus of mental health care. Patients react differently to increased demands and clinicians should be reflexive of the dimensions of individualism–relationalism in medication-free treatment services. Trial registration: This study was registered with ClinicalTrials.gov (Identifier NCT03499080) on 17 April 2018.