Patient Preference and Adherence (Feb 2024)
Medication-Free Treatment in Mental Health Care How Does It Differ from Traditional Treatment?
Abstract
Kari Standal,1 Ole Andre Solbakken,2 Jorun Rugkåsa,3– 5 Margrethe Seeger Halvorsen,2 Allan Abbass,6 Christopher Wirsching,2 Ingrid Engeseth Brakstad,2 Kristin S Heiervang7,8 1District Psychiatric Center Nedre Romerike, Akershus University Hospital, Lørenskog, Norway; 2Department of Psychology, University of Oslo, Oslo, Norway; 3Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; 4Department of Mental Health, Oslo Metropolitan University Oslo, Norway; 5Centre for Care Research, University of Southeastern Norway, Porsgrunn, Norway; 6Faculty of Medicine, Dalhousie University, Nova Scotia, Canada; 7Research and Development Department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; 8Centre of Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, NorwayCorrespondence: Kari Standal, District Psychiatric Center Nedre Romerike, Akershus University Hospital, Akershus universitetssykehus HF, DPS Nedre Romerike, Postboks 1000, Lørenskog, 1478, Norway, Tel +47 679 60 155, Email [email protected]: Norwegian authorities have implemented treatment units devoted to medication-free mental health treatment nationwide to improve people’s freedom of choice. This article examines how medication-free treatment differs from treatment as usual across central dimensions.Methods: The design was mixed methods including questionnaire data on patients 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.Results: Medication-free treatment involved less reliance on medications and more extensive psychosocial treatment that involved a culture of openness, expression of feelings, and focus on individual responsibility and intensive work. The overall extent of patient influence for medication-free treatment compared with standard treatment was not substantially different to standard treatment but varied on different themes. Patients in medication-free treatment had greater freedom to reduce or not use medication. 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. 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 demonstrate its worth as 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–relationism in medication-free treatment services. This knowledge can be used to further develop and improve both medication-free treatment and standard treatment regarding shared decision-making.Trial Registration: This study was registered with ClinicalTrials.gov (Identifier NCT03499080) on 17 April 2018.Keywords: medication-free, mental health care, psychotropics, choice
