Background
Aim
Methods
Design and setting
Participants and recruitment
Data collection
Analysis
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Shielding
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Structure (food, sleep, medication)
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Distractions
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Social life
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Thinking strategies
Ethics
Results
Variables | Total sample | Intervention (contract for self-referral) | Control (treatment as usual) | |
---|---|---|---|---|
No. of participants | 25 | 11 | 14 | |
Gender | Females | 9 | 6 | 3 |
Age (mean (range)) | 41 (21-60) | 44 (31- 58) | 33 (21-60) | |
Diagnosis (some have more than one) | Psychosis (ICD-10; F 20-29) | 19 | 7 | 12 |
Bipolar disorders (ICD-10; F 30-39) | 6 | 4 | 2 | |
Substance use (ICD-10; F 10-19) | 6 | 3 | 3 | |
Others (ICD-10; F 60-61) | 2 | 1 | 1 | |
No. of years since receiving diagnosis (mean (range)) | 9 (2-23) | 10 (4-19) | 8 (2-23) | |
Employment | Paid work | 3 | 2 | 1 |
Disability benefits | 14 | 7 | 7 | |
Sick leave | 3 | - | 3 | |
Studies | Studies or serious plans to study | 5 | 2 | 3 |
Stronger confidence in coping strategies
P: I have discovered that the more I talk to other people… the more stable I am. It is a sort of self-treatment or self-medication. To actively seek contact with other people every day. Some days, when I can’t get in touch with anybody I walk down to the city and look at people. I do that because I don’t want to be alone. That’s a bad idea. Other days I have a strong need to be alone. Then I withdraw, turn off the phone and don’t meet a single person during the whole day. I sit all day and watch TV-series or DVDs or play Playstation games or read a book. And these days come and go. There is no pattern – some days are like this and some days are like that.[…] I: So books help you?P: Yes, it is good to have something where things happen. […] When I read I disappear a little. I disappear a little from this world. I just dream myself into the book. It is very relaxing. And it is a good way to ignore the things I don’t want to think about… things that are stressful to think about.(Male, Control group)
P: I like to eat alone. I do. I have discovered that I like to do some things on my own. […]I have two friends at present and we have a good distance… a good distance. We text each other and meet maybe once a week, and I really appreciate that.I: The friendship?P: Yes, the distance when we meet so rarely. We are in touch on the phone… to state that we are fine. […] I read somewhere that friendship is what you think about the other person […] having a presence even though they are not present.(Male, Intervention group)
Cognitive strategies to influence thinking patterns
P: I am supposed to observe and notice details in rooms and such… when these things happen. I don’t know if it has helped so much. It has become worse and worse. And the feeling is very strong when I am in the midst of it. I almost have to vomit. It affects me physically.(Female, Control group)
P: […] I used to think that everybody knew more than me about certain things. I don’t anymore. […] It’s just confusing… and that’s a difficult state. You become unsure of yourself and that’s heavy. It’s not that I know so much, but what do other people know? […] I read for instance in a book about what happens after death. And I said to myself: How can he [the author] know more about that than me? Has he been there - or is he sitting on this side and imagining what happens afterwards? These simple things… I use tactics like these. Then it is not so bad. […]It still annoys me when someone comes and tells me I can never get rid of it [the illness]. It will probably never be completely over, but… […] There are limits to what I don’t know [laughs]. It is important to believe in the experiences you have. Others might have similar or opposite experiences, but they are not necessarily stronger or more correct.(Male, Intervention group)
P: Nowadays, I read a lot of self-help books. I used to be very skeptical… they had very simple solutions, but now I find them developing.I: What do you get from them?P: I guess they speak to my own problems. You work with yourself while you read. For example to shut out the past… that is described in all self-help books. To have bulkheads forwards and backwards… To think less about worries for the future and self-reproach about the past. That resonates with me… and then the brain works with it while I read.(Male, Intervention group)
Resignation and powerlessness
P: I have accepted the situation I am in. I think I have resigned a little. I have withdrawn from the things that I will never experience.I: Like what?P: Well… [sighs]… my life situation, for instance. I have for instance not had a partner in years… and it is quite stressful because you get very lonely. And after some time you come to a place where you realize that the hopelessness has come to stay.(Male, Control group)
P: Well… how do you move on? It is to work… work with yourself. To locate the problems. Some would say to accept the problems, but that sounds a bit defensive to me. Maybe you get there… when you work with your problems they become more distant. You have to learn to like yourself until you get so sure that you are not put off by any little comment… like I used to be. It was… I had a word that emerged in my head during the last hospitalization: "Show off". That I was a show off. Like I knew it all, and wanted to have a piece of everyone else. But then I asked a friend of mine who was admitted during the same period: Do you think I am a show off? And she laughed a little. That is a way to get your problems more distant. Is it really like this? Is it possible? To be confident… to be sure… that you throw it around instead.(Male, Intervention group)
P: And time heals all wounds. That’s how it is. That’s hard to say when you are ill, but when you are recovering you see that it is a one way street. Even though you might be temporarily dumped or feel bad and upset.I: Like a crisis?P: Yes, the crisis lasts around two hours. It’s like that. I don’t know how other people feel, but when I am ill I feel it could last forever. I am scared that it will be a permanent death row, but it doesn’t. It takes shorter and shorter time before I am well again. And that is reassuring.[…] The problems I have aren’t smaller or steeper, only shorter. It feels like I can put them behind me. Previously I could have days and weeks with the same problems and feel thrown around like a ball. Now it takes three or four hours.(Male, Intervention group)
Being normal and living a normal life
P: I have a diagnosis, and that makes me ill – in medical terms. But it is a difference between that and perceiving yourself as an ill person. Cause I am only a guy. I’m just me.[…] I would like to build a different fundament to base the rest of my life on. To build my whole life on the foundation that I am an ill person in a treatment process… that I have an illness that defines me… I feel that it will be a very unstable life. It will fall apart. So I have decided to find the most stable foundation possible… that’s what I’m trying to do.(Male, Control group)
I: What is the point with having an ambulatory supervisor?P: You press an extra button and get feedback on things that might… that you do well or that people notice… that there are some positive things too. They emphasize it to strengthen your self-confidence. The self-confidence isn’t very strong. You get set back from being admitted. I was away for nine months. I was admitted for nine months. Afterwards you are handicapped. While I was admitted I received my meals every day… some places they helped me get up in the morning. I was helped and supported all the time. And that was difficult to give up. But it is very good to have control over your own life. Cooking and having a nice time… to light candles and… to enjoy living.(Female, Intervention group)
P: I had my job until I realized that it was enough and then I quit.I: You quit?P: Yes. My contract expired… and at the same time I told them I had to quit.I: How was that for you?P: I stayed on the sofa for a week doing nothing. And then I woke up again. It felt like… like I recharged my strength.(Female, Control group)
P: I found out that the deadline for applications was expired, but I called today and they told me it was fine after all. I have a week to make an application for a […] degree to finish the last two years… […] If I can manage to work with art in some way, or with doing odd jobs. It is very exciting and I look forward to writing things this week and to look through my previous work.(Female, Intervention group)
Experiences with a contract for self-referral or treatment as usual
P: I believe in the project with self-referral. It is a pillar… where you know that if something happens which is really bad… You know that you can come here and get a break. It feels safe.(Female, Intervention group)
P: I am very disappointed to be in the control-group [receiving treatment as usual]. I am done with the ordinary mental health services. I just want the self-referral inpatient contract.(Male, Control group)