Rettigheter og tvang i kommunale hjelpetilbud til personer med alvorlige samtidige rus- og psykiske lidelser: erfaringer med regelverket, i lys av menneskerettigheter.

Rights and coercion in municipal services for persons with co-occurring severe mental illness and substance use disorders - experiences with legal framework, in light of human rights. Aims: Persons with co-occurring severe mental illness and substance use disorders can have a considerable need for municipal health and care services but can be difficult to reach with such services. In Norway, there are known perceived ambiguities and obscurities in the legal framework for such services. This study aims to further examine these legal issues in a Norwegian context, by examining what challenges service providers experience in the practice of the current legal framework in this field. Design: The data consists of 13 qualitative interviews with strategically selected service providers from Norwegian municipalities and county governors' offices. The interviews were analyzed through systematic text condensation. Results: The participants reflections resulted in three especially salient perceived challenges in the practice of the current legal framework in this field: 'being dependent upon extra efforts that exceed the legal minimum requirements', 'lacking a legal basis and tools' and 'a complex and composite legal framework'. Conclusions: When seen in light of human rights, the three identified challenges in legal framework should be considered more closely both from a research perspective and from a policy making perspective. It should be investigated further whether human rights oblige the state beyond setting forth minimum requirements, how different human rights impact one another, especially with a view to service providers' rights v. service recipients' rights, and lastly if it is feasible to simplify or clarify the current legal framework to ensure adherence to the law and to promote equal practice among service providers.

Parents' perspectives on user participation and shared decision-making in adolescents' inpatient mental healthcare.

BACKGROUND: Parents are a resource that can be of considerable importance in supporting their adolescents' recovery and shared decision-making processes. However, involving both adolescents and their parents in treatment creates challenges. Understanding the roles of all decision stakeholders is vital to the implementation of shared decision-making and delivery of high-quality healthcare services. OBJECTIVE: The aim of this study is to explore parents' experiences with adolescents' participation in mental health treatment and how parents perceive being involved in decision-making processes. DESIGN: This was a qualitative study with a phenomenological, inductive design. Content analysis of data from qualitative interviews was performed. SETTING AND PARTICIPANTS: This study took place in a Norwegian public healthcare setting. Twelve parents of adolescents who received treatment for severe mental illness participated. RESULTS: Four themes were identified: (1) self-determined treatment, but within limits; (2) the essential roles of parents; (3) the need for information and support; and (4) the fight for individualized treatment and service coordination. CONCLUSION: User participation is vital in adolescent mental healthcare and parents play essential roles regarding the shared decision-making process. However, user participation and shared decision-making pose several dilemmas. Parental involvement in treatment decisions may be necessary when adolescents are mentally ill, but could simultaneously hinder those adolescents' empowerment and recovery. Cooperation among parents, adolescents and healthcare professionals can improve treatment engagement and adherence, but may be challenged by divergent interests. Health services should provide family-oriented services to utilize the potential of parents as a resource and minimize conflicting interests. PATIENT OR PUBLIC CONTRIBUTION: Two adolescent user representatives participated in designing the study.

Interaction rituals in an open drug scene.

AIMS: Open drug scenes can be found in most major cities in Europe. Despite often being closed down by the police, the drug community continues to exist, and the drug scenes reappear elsewhere. There seem to be forces that hold these communities together, regardless of the substances used. In this study we explore whether interaction rituals have an impact on the decision by people to stay in the drug scene or to return after quitting their drug use. METHOD: In this ethnographic study, one of the researchers spent time in an open drug scene in a Norwegian city over a one-year span and gathered data on the human interactions hosted by this scene. In addition, the researcher interviewed eight people from the scene to obtain greater insight into their lives and perceptions of the scene, drawing on Goffman's and Collins's theories about rituals. FINDINGS: Three themes emerged. First, drug users bonded as a group and resisted what they called "normal people" passing by. Second, users demonstrated the importance of sharing drugs and services and adhering to the scene's rules of conduct. The third and final theme is the focus of attention and the production of emotional energy. CONCLUSION: The experience of being outsiders and the need to hide some of their activities seemed to make it necessary for persons in the drug scene to have their own rules and rituals. These rules and rituals can be regarded as "interaction rituals". They provide participants with the symbols of group membership, emotional energy, and group solidarity. This makes it hard to leave the scene and might explain why those who do often return.

I'm not a diagnosis: Adolescents' perspectives on user participation and shared decision-making in mental healthcare.

BACKGROUND: Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services that is both suitable for adolescents and in line with policy. Shared decision-making has the potential to combine user participation and evidence-based treatment. Research and governmental policies emphasize shared decision-making as key for high quality mental healthcare services. OBJECTIVE: To explore adolescents' experiences with user participation and shared decision-making in mental healthcare inpatient units. METHOD: We carried out ten in-depth interviews with adolescents (16-18 years old) in this qualitative study. The participants were admitted to four mental healthcare inpatient clinics in Norway. Transcribed interviews were subjected to qualitative content analysis. RESULTS: Five themes were identified, representing the adolescents' view of gaining trust, getting help, being understood, being diagnosed and labeled, being pushed, and making a customized treatment plan. Psychoeducational information, mutual trust, and a therapeutic relationship between patients and therapists were considered prerequisites for shared decision-making. For adolescents to be labeled with a diagnosis or forced into a treatment regimen that they did not initiate or control tended to elicit strong resistance. User involvement at admission, participation in the treatment plan, individualized treatment, and collaboration among healthcare professionals were emphasized. CONCLUSIONS: Routines for participation and involvement of adolescents prior to inpatient admission is recommended. Shared decision-making has the potential to increase adolescents' engagement and reduce the incidence of involuntary treatment and re-admission to inpatient clinics. In this study, shared decision-making is linked to empowerment and less to standardized decision tools. To be labeled and dominated by healthcare professionals can be a barrier to adolescents' participation in treatment. We suggest placing less emphasis on diagnoses and more on individualized treatment.

Stuck in limbo: illicit drug users' experiences with opioid maintenance treatment and the relation to recovery.

OBJECTIVE: The objective of this article is to gain insight into how individuals who frequent open illicit drug scenes experience opioid maintenance treatment (OMT) and investigate how this appears to affect their recovery processes. METHOD: By means of the ethnographic method, one of the researchers spent time in an open illicit drug scene over a 1-year span, and gathered data on individuals who frequent the scene on a regular basis, and their experiences with OMT. The data are based on field notes and audiotaped interviews. FINDINGS: Four themes emerged as relevant for the participants' experiences with OMT: 1) the loss of hope, 2) trapped in OMT, 3) substitution treatment is not enough, and 4) stigmatization of identity. CONCLUSION: The participants found the OMT to be overruling and degrading. Several of the individuals from the illicit drug scene are part of the OMT programme, but as the treatment does not remove painful emotions, they supplement OMT with illegal substances, violate the OMT regulations, and run the risk of being excluded from the programme. In fear of losing the replacement opioid, they conceal parts of the addiction they seek treatment for and end up lying and cheating instead of exploring strategies for reducing and managing the addiction. The patients' relation to the OMT personnel is negatively affected by the need to hide a large portion of their issues. The result is a feeling of hopelessness, increased stigmatization, lack of control and being trapped between two worlds-in limbo, an intermediate state which interferes with the recovery process.