Citation

Langjord T, Pedersen G, Bovim T, Bremer K, Christensen TB, Hove O, Kildahl AN, Mork E, Norheim AB, Ramleth RK, Romm KL, Siqveland J, Schønning T, Stänicke LI, Torgersen T, Pettersen MS, Tveit T, Urnes, Walby FA, Kvarstein EH. Nord. J. Psychiatry 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Informa - Taylor and Francis Group)

DOI

10.1080/08039488.2024.2376162

PMID

39126325

Abstract

BACKGROUND: Extensive psychiatric hospitalization due to repeated severe self-harm (SH), is a poorly researched area, but a challenge within health services (HS). Recent studies have demonstrated high levels of involuntary treatment among patients with severe personality disorder (PD) and complex comorbidity. Keeping focus on extensively hospitalized SH patients, this study aimed to investigate patients' and clinicians' evaluation of HS and treatment alliance.

METHOD: A cross-sectional study with an inpatient sample (age >18 years) with frequent (>5) or long (>4 weeks) psychiatric hospital admissions last year due to SH or SA recruited from 12 hospitals across health regions (N = 42). Evaluation included patient and clinician report.

RESULTS: A minority of the patients (14%) were satisfied with HS before the current admission, 45% (patients) and 20% (clinicians) found the current admission helpful, and 46% (patients) and 14% (clinicians) worried about discharge. Treatment complaints were received in 38% of the cases. Outpatient mental HS were available after discharge for 68% and a majority of clinicians indicated satisfactory contact across HS. More intensive or specialized formats were unusual (structured outpatient treatment 35%, day treatment 21%, ambulatory services 32%, planned inpatient services 31%). Mutual problem understanding, aims, and confidence in therapists during the hospital stay were limited (patient-rated satisfactory mutual problem understanding: 39%, aims of stay: 50%, confidence: 50%). Patient and therapist alliance-ratings were in concordance for the majority.

CONCLUSION: The study highlights poor HS satisfaction, poor patient-therapist coherence, limited treatment alliance and limited follow-up in structured treatments addressing SH or intermediary supportive ambulatory/day/inpatient services.

Language: en

Keywords

Self-harm; suicide attempts; mental health services; complex comorbidity; hospitalization; treatment collaboration