Individual Music Therapy for Mental Health Care Clients With Low Therapy Motivation: Multicentre Randomised Controlled Trial

BACKGROUND: Music therapy (MT) has been shown to be efficacious for mental health care clients with various disorders such as schizophrenia, depression and substance abuse. Referral to MT in clinical practice is often based on other factors than diagnosis. We aimed to examine the effectiveness of resource-oriented MT for mental health care clients with low motivation for other therapies. METHOD: This was a pragmatic parallel trial. In specialised centres in Norway, Austria and Australia, 144 adults with non-organic mental disorders and low therapy motivation were randomised to 3 months of biweekly individual, resource-oriented MT plus treatment as usual (TAU) or TAU alone. TAU was typically intensive (71% were inpatients) and included the best combination of therapies available for each participant, excluding MT. Blinded assessments of the Scale for the Assessment of Negative Symptoms (SANS) and 15 secondary outcomes were collected before randomisation and after 1, 3 and 9 months. Changes were analysed on an intention-to-treat basis using generalised estimating equations in longitudinal linear models, controlling for diagnosis, site and time point. RESULTS: MT was superior to TAU for total negative symptoms (SANS, d = 0.54, p \u3c 0.001) as well as functioning, clinical global impressions, social avoidance through music, and vitality (all p \u3c 0.01). CONCLUSION: Individual MT as conducted in routine practice is an effective addition to usual care for mental health care clients with low motivation

Local authorities and the engagement of private actors in climate change adaptation

The local level and private actors play an important role in the implementation of climate change adaptation. The engagement of the private sector and citizens has received increasing attention in recent years. Local authorities' choice of policy instruments, the distribution of responsibilities and the benefits of adaptation as a public or a private good have a bearing on the involvement of private actors. Based on interviews and documents from Copenhagen and Helsinki, we analyse how public authorities' choices, to whom and how they shift responsibilities, can foster transformational, participatory or market-oriented elements of adaptation. The results indicate that local authorities play a dominant role in providing adaptation. Public authorities steer where the private sector and citizens are expected to take responsibilities. This mix of top-down steering, market mechanisms and citizen involvement might reduce the advantages that a shift of responsibilities towards private actors could provide for the handling of climate change adaptation