Medication-free treatment in mental health care. How does it differ from traditional treatment?

Abstract

Abstract Background: Norwegian health authorities have implemented treatment units devoted to medication-free mental health treatment in all health regions to improve people’s freedom of choice. This article examines how medication-free treatment differs from treatment as usual across various central dimensions. Methods: The design was a preplanned, parallel, multi-sample, observational, mixed-methods design including questionnaire data obtained 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. The medication-free unit was compared to data from comparison units on questionnaire data and participants’ other treatment (patents) or work (staff) experiences in interviews. 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 similar to standard treatment, but varied on different themes. Patients in medication-free treatment had more 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 show that it can be 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–relationalism in medication-free treatment services. Trial registration: This study was registered with ClinicalTrials.gov (Identifier NCT03499080) on 17 April 2018.