‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study

Abstract

Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents’ experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.

Staff’s experiences of implementing patient-initiated brief admission for adolescents from the perspective of epistemic (in)justice

“…In order for staff to facilitate agency and recovery among adolescents, it was considered important to adapt PIBA from the adult setting and thus make adjustments to the youth context [cf. ( 13 )] that includes parents. Part of the recovery research on young people is about how care can be optimized and developed to best facilitate a recovery-oriented approach ( 33 , 37 ).…”

“…Through this (tentative) approach, we suggest that there is an explicit idea that PIBA may promote recovery and epistemic justice also for young people since they, to a greater degree, have the possibility to define and voice their needs rather than others defining and voicing these for them [cf. ( 12 , 13 )]. Providing PIBA to certain adolescents in CAP may change traditional structures of power and knowledge legitimacy.…”

“…By primarily focusing on individual and collective behavior, these components aim to help us to understand implementation and, above all, to normalize new interventions in clinical settings. Since implementing PIBA in CAP may be a way of promoting epistemic justice and recovery ( 13 ) it is described as crucial in order to grasp the underlying factors that either facilitate or complicate this process, which is why implementation theories become useful when trying to describe the clinical work performed by staff.…”

Attitudes towards clinical and non-clinical services among individuals who self-harm or attempt suicide: A systematic review

“…The gender profiles of participants were reported in 25 studies. While one study included only female participants (Lindkvist et al, 2021) and one included only male participants (Hassett & Isbister, 2017), all other studies included a mix of female and male participants, with four studies including transgender, non-binary or other genders. Only three studies reported on participants' ethnicity, all of which included exclusively or majority White participants.…”

“…However, others felt that they could call on staff freely within brief admission wards and also a sense of predictability and safety, unlike in busy and intense EDs (Lindkvist et al, 2021).…”