Healthcare Professionals' Experiences of Brief Admission by Self-Referral for Adolescents with Self-Harm at Risk of Suicide-A Qualitative Interview Study.

Abstract

Brief Admission by Self-referral (BA), a standardized crisis intervention for individuals with repeated self-harm or suicidal behavior, was adapted for adolescents from 13 years in Region Skåne, Sweden, in 2018. BA aims to offer access to support based on autonomy and has been associated with reduced need of emergency care. Interviews with adolescents and legal guardians have pointed to BA as valuable and challenging, and professional support as key. This study aims to describe healthcare professionals' (HCPs) experiences of BA for adolescents with self-harm at risk of suicide. Interviews six years after implementation with fourteen HCPs from outpatient and inpatient psychiatric care were analyzed with qualitative content analysis. BA was perceived as valuable caretaking without taking over, promoting mental growth and agency by being brief and granting access. It was described as offering relief to families and HCPs, although perceived to lack a sufficient level of legal guardian participation. Key work processes included being grounded in leadership and outpatient treatment. Challenges included system inflexibility and fitting BA into the physical care context. The results of this study may support future implementation of BA for adolescents with self-harm at risk of suicide and add guidance around potential pitfalls.