<abstract xmlns="http://www.w3.org/1999/xhtml"><sec><h3>Background:</h3><p>Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services that is both suitable for adolescents and in line with policy. Shared decision-making has the potential to combine user participation and evidence-based treatment. Research and governmental policies emphasize shared decision-making as key for high quality mental healthcare services.</p></sec><sec><h3>Objective:</h3><p>To explore adolescents’ experiences with user participation and shared decision-making in mental healthcare inpatient units.</p></sec><sec><h3>Method:</h3><p>We carried out ten in-depth interviews with adolescents (16-18 years old) in this qualitative study. The participants were admitted to four mental healthcare inpatient clinics in Norway. Transcribed interviews were subjected to qualitative content analysis.</p></sec><sec><h3>Results:</h3><p>Five themes were identified, representing the adolescents’ view of gaining trust, getting help, being understood, being diagnosed and labeled, being pushed, and making a customized treatment plan. Psychoeducational information, mutual trust, and a therapeutic relationship between patients and therapists were considered prerequisites for shared decision-making. For adolescents to be labeled with a diagnosis or forced into a treatment regimen that they did not initiate or control tended to elicit strong resistance. User involvement at admission, participation in the treatment plan, individualized treatment, and collaboration among healthcare professionals were emphasized.</p></sec><sec><h3>Conclusions:</h3><p>Routines for participation and involvement of adolescents prior to inpatient admission is recommended. Shared decision-making has the potential to increase adolescents’ engagement and reduce the incidence of involuntary treatment and re-admission to inpatient clinics. In this study, shared decision-making is linked to empowerment and less to standardized decision tools. To be labeled and dominated by healthcare professionals can be a barrier to adolescents’ participation in treatment. We suggest placing less emphasis on diagnoses and more on individualized treatment.</p></sec></abstract>

Background:Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services that is both suitable for adolescents and in line with policy. Shared decision-making has the potential to combine user participation and evidence-based treatment. Research and governmental policies emphasize shared decision-making as key for high quality mental healthcare services.Objective:To explore adolescents’ experiences with user participation and shared decision-making in mental healthcare inpatient units.Method:We carried out ten in-depth interviews with adolescents (16-18 years old) in this qualitative study. The participants were admitted to four mental healthcare inpatient clinics in Norway. Transcribed interviews were subjected to qualitative content analysis.Results:Five themes were identified, representing the adolescents’ view of gaining trust, getting help, being understood, being diagnosed and labeled, being pushed, and making a customized treatment plan. Psychoeducational information, mutual trust, and a therapeutic relationship between patients and therapists were considered prerequisites for shared decision-making. For adolescents to be labeled with a diagnosis or forced into a treatment regimen that they did not initiate or control tended to elicit strong resistance. User involvement at admission, participation in the treatment plan, individualized treatment, and collaboration among healthcare professionals were emphasized.Conclusions:Routines for participation and involvement of adolescents prior to inpatient admission is recommended. Shared decision-making has the potential to increase adolescents’ engagement and reduce the incidence of involuntary treatment and re-admission to inpatient clinics. In this study, shared decision-making is linked to empowerment and less to standardized decision tools. To be labeled and dominated by healthcare professionals can be a barrier to adolescents’ participation in treatment. We suggest placing less emphasis on diagnoses and more on individualized treatment.

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Background:Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services...

Meaning unit	Condensation	Sub-theme	Theme
The most important thing for me is to be listened to and taken seriously. I have struggled a lot with that. I am afraid not to be taken seriously or believed. So, then I rather say nothing.	To be and taken seriously and listened to and believed is necessary to talk/engage.	Being seen and heard Expectations	To gain trust
They sit and write about me three times a day, but they don’t actually know me. They just make their own conclusions.	They make conclusions about me without knowing me.	Assessment and diagnosis	To be diagnosed and labeled
I don’t like that an adult should decide on my behalf. Then I have nothing to say, it’s just how they decide. I think that is very degrading.	Don’t like adults deciding for me. It is degrading.	Treatment decisions Coercion and resistance	Push me, and I don’t want to follow

Participant ID number	Duration of admission	Total-experience from CAMHS	Self-reported diagnosis
1	N/A	3 years	Autism spectrum disorder, psychosis
2	9 days	2 years	Anxiety, depression
3	12 days	1 year	ADHD, eating disorder
4	6 months	8 months	N/A
5	7 days	3 years	Trauma/PTSD
6	7 days	1 week	Depression, anxiety
7	22 days	4 years	ADHD, anxiety, depression
8	21 days	1 year	Depression, ADHD, anxiety
9	7 days	1 year	Depression, autism spectrum disorder
10	6 months	1.5 year	Psychosis, anxiety

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

Published Online: Sep 19, 2020

Page range: 139 - 148

DOI: https://doi.org/10.21307/sjcapp-2020-014

Keywords
adolescent, mental health, user participation, shared decision-making, inpatient, qualitative study

© 2020 Stig Bjønness et al., published by sciendo.

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Example of structural analysis

Participants’ self-reported experience with mental healthcare services and diagnosis

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

Published Online: Sep 19, 2020

Page range: 139 - 148

DOI: https://doi.org/10.21307/sjcapp-2020-014

Keywordsadolescent, mental health, user participation, shared decision-making, inpatient, qualitative study

© 2020 Stig Bjønness et al., published by sciendo.

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Example of structural analysis

Participants’ self-reported experience with mental healthcare services and diagnosis

Keywords
adolescent, mental health, user participation, shared decision-making, inpatient, qualitative study