Medication-Free Treatment in Mental Health Care: Characteristics, Justification, and Clinical Outcomes

Abstract

Background: To improve patients’ freedom of choice, Norwegian authorities have implemented treatment units devoted to medication-free mental health treatment (MFT). These units are designed to offer alternatives to medication, with the intention of being free from medication pressure and coercion while providing alternative options. This nationwide implementation is historically unprecedented and has been a source of controversy, particularly regarding the knowledge base and the appropriateness of separate units. This thesis illuminates the place for medication-free treatment units in terms of reasons for wanting this kind of treatment service, outcomes compared to treatment as usual (TAU), and the characteristics of this kind of service. Methods: With a mixed-methods and observational design, we compared an MFT inpatient unit with two ordinary inpatient units according to validated measures of health and treatment experience for 183 participants as well as a dataset of 378 participants on the main outcome measure. In addition, we performed qualitative interviews with five patients and eight staff from the MFT unit. Results: Our study indicated that patients desired MFT services for several reasons: they had experienced negative effects of medications and found alternatives in ordinary health care to be unavailable. Additionally, their personal values, attitudes, or beliefs influenced their preference for MFT. The health outcomes at the end of treatment were comparable to those of TAU. MFT was characterized by less focus on medications, more focus on psychosocial interventions, more support for choosing a less medication-focused path to recovery, and a more restrictive policy regarding controlled substances. More was expected of patients in terms of both activity and responsibility, which could be experienced as both empowering and/or pressure. Overall measures related to patient influence (e.g., therapeutic alliance, shared decision-making, support for personal recovery) did not differ substantially from TAU. Patients in the medication-free unit reported higher satisfaction with their treatment, which may be linked to a richer psychosocial treatment program that emphasized patient participation and freedom from medication pressure. Conclusions: A treatment service characterized by less focus on medications, more focus on psychosocial treatment, and more support for choosing a less medication-focused pathway to recovery could provide treatments with greater patient satisfaction and comparable health outcomes to treatment as usual. The similar health outcomes as those found in TAU were in line with previous investigations of similar undertakings, but this is the first study to compare a Norwegian MFT unit with TAU. Negative medication effects and unavailable alternatives in standard health care were important reasons for why people want such services. We need more knowledge about the long-term outcomes and the cost-effectiveness of different treatment strategies. Shared decision-making is complex; therefore, it is important to understand more about how to create a health-care system that is flexible enough to accommodate individual patients’ needs. The present study contributes toward this understanding.