Medication free treatment for people with psychosis: An explorative study of user perspectives on increased accept and support for patients choosing to discontinue anti-psychotic medication as treatment for psychosis

Bakgrunn: Medisinfri behandling for psykose i Norge er et resultat av et felles initiativ fra flere brukerorganisasjoner basert på den debatterte bruken av antipsykotiske medisiner, og ønsket om mer personsentrert behandling og større selvbestemmelse. Medisinfri behandling har som mål å øke pasientens autonomi, redusere medikamentell behandling og øke psykososiale støttemuligheter. Medikamentfri behandling var ikke utformet for å fremme ett behandlingsvalg fremfor et annet. I praksis står pasienter som velger dette behandlingsprogrammet fritt til å bruke eller ikke bruke medisiner etter deres behov, men må ha et klart mål om å redusere eller slutte med antipsykotisk medisinering. Mål: Denne studiens mål var å gi omfattende innsikt i brukerens og helsepersonells erfaringer med det medisinfrie behandlingsprogrammet i Bergen, Norge. Metoder: Dette er en kvalitativ studie som brukte dybdeintervjuer med personer med psykose, fokusgruppesamtaler med ansatte tilknyttet medisinfri behandling, og deltakende observasjon i musikkterapi. Fire erfaringseksperter ble invitert som medforskere. Funn: Pasientene beskrev sitt forhold til terapeutene som viktig og forbedret. Behandlingen ble en læringsprosess av deres personlige lidelsesmønstre. Motivasjon for å ta kontroll over egen tilfriskningsprosess var viktig. Terapeutene var opptatt av å forvalte ressurser; sin egen rolle i terapien; og ulike pasientvalg. Musikkterapi ble beskrevet som en fleksibel og recoveryorientert behandling. Konklusjoner: Medisinfri behandling la til rette for læringserfaringer angående behandlingsvalg med fokus på økt egenstyring og motivasjon. Behandlingen fremstår støttende for ulike pasientvalg, og ser ut til å forbedre forholdet mellom pasient og helsepersonell. Demokratisering av behandlingsvalg utfordrer nivået av faglig skjønn når helsepersonell og pasient har motstridende mål. Dette kan føre til at terapeuter føler seg maktesløse i og fremmedgjort fra arbeidet sitt. Musikkterapi tilbyr valg fortløpende, i samarbeid med terapeut, men også avhengig av omstendigheter. Det er et potensial for forbedret implementering.Background: Medication-free (MF) treatment for psychosis in Norway is the result of a joint initiative from several user organisations based on the debated use of anti-psychotic medication, and the wish for more person-centred care and greater self-determination. MF treatment aims to increase patient autonomy, reduce pharmacological treatment, and increase psychosocial support options. The medication-free treatment services were not designed to promote one treatment choice over another. In practical terms, patients choosing this treatment program are free to use or not use medications following their needs, but aims to reduce or discontinue their anti-psychotic medication. Objective: This study aimed to provide comprehensive insight into the user and provider experiences with the medication free treatment program in Bergen, Norway. Methods: This was a qualitative study using in-depth interviews with people with psychosis, focus group discussions with staff from the mental health care institutions, and participant observation in music therapy. Four experts by experience were invited as co-researchers. Findings: Patients described their relationship with therapists as improved and significant. Treatment was a learning process of their personal patterns of suffering, and motivation for self-agency in the recovery process was important. The therapists were preoccupied with managing resources; their role in the therapy; and patient choices. Music therapy was described as a flexible, recovery-oriented treatment. Conclusions: Medication-free treatment facilitated learning experiences regarding the choice of treatment, focusing on increased self-agency and motivation. It is supportive towards patient choices, and appears to improve the relationship between the patient and the caregiver. Democratization of treatment choices challenges the level of professional discretion when caregiver and patient have conflicting goals, possibly causing therapists to feel disempowered in and alienated from their work. Music therapy offers choices continuously, in collaboration with the therapist, but also contingent depending on circumstances. There is a potential for improved implementation.Doktorgradsavhandlin

How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway

Background Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment. Methods We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky’s theoretical framework on the role public health workers play in policy implementation. Findings Following Norway’s new policy was challenging for the therapists in our study, particularly balancing a patient’s needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients’ conditions worsening. Conclusions Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work.publishedVersio

Health care workers’ perspectives on the challenges and possibilities of music therapy within medication-free treatment services

Introduction In 2015, the Norwegian Regional Health Authorities introduced the possibility for people with psychotic disorders to choose medication-free services, with music therapy as a treatment option. This study aimed to explore the health care workers’ perspectives on challenges and possibilities of music therapy within these services. Method This is a qualitative study by an interdisciplinary research team, including experts by experience. Ethnographic notes provide data from participant observation with one patient using music therapy, describing what music therapy can be “a case of”. Focus group discussions (FGDs) with health care workers, including music therapists, explore their experiences with music therapy and medication-free treatment. These were transcribed and analyzed using systematic text condensation in a stepwise, iterative process involving co-authors to ensure reflexivity. Results The summary from the participant observation provides the reader with background information on how music therapy can unfold in mental health care. The informants from the FGDs described music therapy as having a high degree of treatment flexibility providing a continuous process of choices. The collaborative choices both among staff members as well as between patient and staff were experienced as important for treatment outcome. Patients worsening or stagnating increased the significance of contingent choices. Discussion The strengths of music therapy, such as its acceptability and flexibility, also represent challenges, including dilemmas of prioritization, challenges when ending therapy, and the need for close collaboration when assessing a patient’s worsening. There is a potential for improving the implementation of music therapy into the existing health care teams.publishedVersio

How can we best help this patient? Exploring mental health therapists’ reflections on medication-free care for patients with psychosis in Norway

Background Since 2015, Norwegian Regional Health Authorities have followed new government policy and gradually implemented medication-free services for patients with psychosis. The aim of this qualitative study was to explore the tension between policy and practice, and how health care workers in Bergen reflect on their role in implementing medication-free treatment. Methods We performed three focus group discussions including 17 therapists working within medication free services, asking about their experiences with this new treatment program. We used Systematic Text Condensation for data analysis. The findings were discussed using Michael Lipsky’s theoretical framework on the role public health workers play in policy implementation. Findings Following Norway’s new policy was challenging for the therapists in our study, particularly balancing a patient’s needs with treatment guidelines, the legal framework and available resources. Therapists had an overarching wish to help patients through cooperation and therapeutic alliance, but their alliance was sometimes fragile, and the therapists worried about patients’ conditions worsening. Conclusions Democratization of treatment choices, with the aim of empowering patients in mental health care, challenges the level of professional discretion given that patients and therapists might have conflicting goals. Balancing the desire to help, professional responsibility, the perceived lack of resources, and certain patient choices created conditions that can leave therapists feeling disempowered in and alienated from their work