Brief admission by self-referral for adolescents who self-harm: discourses on involvement and responsibility among parents and other significant adults.

Abstract

Background: Brief Admission by self-referral (BA) was implemented in 2018 in Swedish child and adolescent psychiatric (CAP) inpatient care. This intervention empowers adolescents to self-admit at their own request for brief periods to prevent self-harm and suicidal crisis. As BA enhances healthcare user autonomy, it is a timely intervention to consider with the emerging human rights discourse and rising imperatives for person-centered care in psychiatry. The present study explores talk about adolescents access to BA specifically in terms of involvement and responsibilities of parents and other significant adults in CAP.

Methods: In this qualitative study, we interviewed 26 significant adults (the majority being biological parents) of children with access to BA. Interviews were semi-structured, asking broadly about participants' experiences with BA. We used reflexive thematic analysis from a social constructionist framework to explore how participants' narratives drew on existing psychiatric discourses.

Results: We constructed four themes around narratives of involvement and responsibilities in BA specifically and CAP generally: there's no need to be involved in BA, selflessly supporting child involvement, being insufficiently involved, and being left to shoulder everything. These themes illustrate a sliding scale from perceiving little responsibility nor need for involvement, to perceiving shared responsibility for children's well-being but limited personal rights, to being under-involved and even perceptions of being left with sole responsibility as CAP refused to provide care.

Conclusions: Participants' narratives could generally be mapped onto rights-based discourse, emphasizing that adolescents should have access to BA as it helped them care for themselves. As participants took various positions regarding the responsibility of parents versus CAP to protect and help adolescents, the risk of perpetually downplaying the needs of parents and other significant adults became apparent, along with the pitfalls of neoliberal healthcare management and responsibilization of child mental health. CAP ought to systematically inform both adolescents and significant adults about BA, strengthening mental health literacy among the target population. It also ought to be emphasized that supporting significant others is considered part of the purpose with BA.