Brief admission by self-referral for individuals with self-harm and suicidal ideation: a qualitative study based on focus groups exploring relatives’ experiences

ABSTRACT

Purpose

Brief Admission by self-referral (BA) is a standardized crisis-management intervention for individuals with self-harm and risk for suicide. This study explored relatives’ experiences of BA. Relatives’ perspectives may contribute to an increased understanding of the effects of BA given the relatives’ role as support and informal caregivers as well as being co-sufferers.

Methods

Fourteen relatives to adults with access to BA within one Swedish region participated in focus groups analysed with reflexive thematic analysis.

Results

We generated themes evolving around three meaning-based concepts: access (A low threshold to a safe back-up is crucial and obstacles may easily break faith), independence (Trust in their ability with care and respect), and recovery (The rest and relational recovery we all get are needed and invaluable).

Conclusions

BA brings considerable value to users and relatives, by supporting them to take care of themselves and each other. Communication and involvement of relatives may enhance users’ ability to overcome obstacles to accessing BA. Implementation and adherence may be strengthened by supervision of BA staff and education of emergency care staff. Resources are needed to improve access. Mapping hurdles to BA, support through peers and targeted psychoeducation may improve recovery for BA users and their relatives.

KEYWORDS:

• Self-harm
• suicidal ideation
• brief admission
• relatives
• prevention
• reflexive thematic analysis
• psychiatric inpatient care

Acknowledgments

The authors wish to thank Lena Kastengren with helping in the recruitment of participants by sending out letters with study information to adults with Brief Admission contracts in Skåne.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contribution

RL was involved in conceptualization and design, informed, and scheduled the participants, moderated the focus groups, transcribed, led the analysis process, and wrote draft manuscripts. JE and KL were involved in conceptualization and design, participated as assistant moderators during focus groups, and were involved throughout the analysis process. SW was involved in conceptualization and design, but due to her clinical undertakings, she did not have access to data or participate in analyses. All authors significantly contributed to the manuscript and read and approved the final version.

Data availability statement

Focus groups supporting the findings of this study are not publicly available due to privacy.

Additional information

Funding

This work was supported by the Mats Paulsson Foundation.

Notes on contributors

Rose-Marie Lindkvist

Rose-Marie Lindkvist MSc, is a PhD student at Lund University with a background in health economics and public health and with experience in qualitative research.

Joachim Eckerström

Joachim Eckerström RN, PhD, is specialized in psychiatric nursing interventions, such as BA. Currently working as a postdoc focusing on BA, and virtual patients as an educational learning method. Also working part-time as a nurse in psychiatry and as a lecturer at Karolinska Institutet.

Kajsa Landgren

Kajsa Landgren RN, PhD, is an associate professor at Lund University and specialized in psychiatric nursing and experienced with qualitative research.

Sofie Westling

Sofie Westling MD, PhD, is associate professor and lecturer, clinical researcher at Lund University and senior psychiatrist working clinically with self-harm in adult psychiatry in Region Skåne, including being senior psychiatrist at the BA ward in Lund.