Individuals’ experiences with brief admission during the implementation of the brief admission skåne RCT, a qualitative study

Abstract

Background: Brief admission (BA) is an adjunctive treatment option for individuals with self-harming behavior, having traits of borderline personality disorder (BPD). It is offered alongside outpatient psychotherapy for the purpose of strengthening autonomy, self-reflection and self-care and to increase the likelihood of being able to stay in therapy by avoiding lengthy inpatient hospitalizations.

Aims: To investigate participants’ experiences with BA during the pilot phase of the Brief Admission Skåne Randomized Controlled Trial (BASRCT), in order to detect possible strengths and limitations of the intervention and gain knowledge to facilitate implementation of BA at other treatment centers.

Method: Eight participants randomized to BA were interviewed to obtain their experience of BA, or alternatively their reasons for choosing not to use BA. Thematic analysis was conducted upon their transcribed interviews.

Results: Reported as most helpful by the participants was the structure/routines at the ward and the positive attitudes from the staff. However, some individuals reported problems with perceived negative attitudes from the staff administering BA and negative rumination about themselves. The reported reasons to request BA were: preventing urges to self-harm from escalating; ending isolation; preventing longer admissions and forced admission; feelings of emotional exhaustion, and the need for rest and support in re-creating a daily routine. Reasons for not requesting BA were fear of rejection, questioning the method; presumed room shortage; difficulties in deciding whether one’s problems are serious enough; experiencing the situation to be too clinically acute.

Conclusion: The results from this study indicated the importance of repeated staff education on all aspects of BA when it is being newly implemented, as well as the importance of working with attitudes of staff delivering BA. These were the key ingredients in making BA implementation successful. Our findings may be of value to other treatment centers implementing BA for the first time.

Trial registration: NCT02985047.

Keywords:

• Brief admission skåne
• self-harm
• suicide
• borderline personality disorder
• implementation
• attitudes

Acknowledgments

We generously thank the interviewed individuals for their time and for sharing their personal experiences with BA. We thank Professor Lena Flyckt as applicant for the Swedish Research Council Grant [number 2015-02446]. We thank Reid Lantto for the translation of the results.

Disclosure statement

The authors declare that they have no financial or other competing interests.

Additional information

Funding

This work was supported by the Swedish Research Council; under Grant [number 2015-02446]; Mats Paulsson Foundation, The Swedish National Self-Injury Project, Regional research funds (Södra Regionvårdsnämnden), Söderström-Königska Foundation, Ellen and Henrik Sjöbring Foundation, OM Persson Foundation, and Maggie Stephens Foundation.