‘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
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Setting
2.3. BA, Adapted for Adolescents
2.4. Participants
2.5. Data Collection
2.6. Data Analysis
2.7. Ethical Considerations
3. Results
3.1. Feeling Safe and Relieved
3.1.1. Being Welcomed by Professionals
“I was afraid of what I might do to myself. And I just felt like it is better if I am somewhere where they know what to do and can take care of me.”(I 15)
”/When I arrive/ we review my contract. But sometimes, when I’ve been very tired, they’ve let me skip that step.”(I 3)
“You get to talk about it without any pressure… Just getting to talk about it with someone who, well, just listened.”(I 5)
3.1.2. Having Access with Less Drama
“When you are going in urgently /via the emergency services,/ it is often a very dramatic experience. It has been a sense of safety, knowing that if I’ve tried everything and it hasn’t worked, then I have /BA/ to lean upon.”(I 5)
“When you see a physician at the emergency unit, you are not sure to be admitted. And explaining why you wish to be admitted is very hard on you. And they don’t always listen to you. So, it’s a relief not needing to justify yourself and try to argue your case when you’re in very bad shape.”(I 8)
“It has meant quite a lot to me. It’s been rather helpful, even though I’ve never used it.”(I 11)
3.1.3. Saving Yourself from Impulses to Self-Harm
“Before, I was acting on impulses when I harmed myself. But with BA, when I have those thoughts and I want to do it, I call /the unit/ instead. So that it sort of turned into a mechanism of diversion.”(I 12)
“I believe it has resulted in more admissions and helped me more with self-harm… Without BA, I don’t think I would have sought so much help.”(I 3)
3.1.4. Reducing the Burden on Loved Ones
“When we were approached about signing a BA contract, it was almost like the whole family could breathe. There. Like, now we are safe. Now we have somewhere to call if something happens.”(I 17)
3.2. Growing from Self-Reflection and Effort
3.2.1. Timely Rest and Recovery
“BA enabled me to make it through the whole semester because I was able to take a break every once in a while, when things got too hard. Instead of exhausting myself and only then taking a break.”(I 7)
“It wasn’t like I suddenly felt all damn fine. That’s not how it works. But still, it felt like I had gotten some time to breathe. And to, like, take a break. And that I could actually tackle my problems when I get out.”(I 15)
3.2.2. BA Being Hard but Helpful
“There are lots of thoughts going around in my head. Do I really need /BA/ right now?... Still, I’ve learnt that when I think the thought, that’s when I need /BA/. And if I wait, then I will most likely end up on an /emergency/ admission after a while anyway.”(I 2)
“If you did something destructive, then you were discharged immediately. I didn’t think that was very good because, like, that’s precisely when you need help.”(I 18)
“It is two entirely different starting points. I mean, /emergency/ admission feels like a failure and with BA I’m like proud of myself, ‘cause I could ask for help in time.”(I 2)
3.2.3. Feeling Free and Independent
“It feels good to go out for a walk sometimes. And just clear my head. And then I have the opportunity to do so. … Sometimes that’s been hard when I have been on a regular emergency admission. Not being able to go outside without having someone accompany me. And be there like a shadow.”(I 17)
“I have such difficulty asking for help in general. And… being admitted a little bit against my own will. But somehow it gets easier when… when I am the one who wants it. Also like, knowing that, well, I can go home at any time.”(I 2)
“It’s good that you can tailor /BA/ yourself to such a high degree. But also, that you can just say ‘it doesn’t matter, it depends, ask me when I arrive.’ Everyone can have it just the way they wish.”(I 8)
3.3. Receiving Insufficient Attention
3.3.1. Facing Unprofessional Behavior
“I asked if I could go outside. And then there was someone saying ‘no, … you have to talk to the physician first.’ So I said ‘no, I’m on BA. … Check my contract’.”(I 7)
3.3.2. Being Less Prioritized
“It could be that you were forgotten and not called to meals. Because, before /when I was on emergency admissions/ they always came and said, ‘it’s mealtime.’ But on BA it was like I was, well, forgotten.”(I 19)
“At 8 pm, it’s like, okey, if I feel bad then I will have to go the emergency unit. … /Like/, “oh no, now it’s 8 pm. Now it’s too late. What do I do now?””(I 9)
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Self-estimated duration of BA contract in months, median (range) | 12 (2–36) |
No. of adolescents who had renewed their contract at least once, N (%) | 8 (42%) |
Extent of using BA, no. of times, N (%) | |
0 times | 2 (11%) |
1 time | 3 (16%) |
2–5 times | 9 (47%) |
6–10 times | 2 (11%) |
>10 times | 3 (16%) |
Feeling Safe and Relieved | Growing from Self-Reflection and Effort | Receiving Insufficient Attention |
---|---|---|
Being welcomed by Professionals | Timely rest and recovery | Facing unprofessional behavior |
Having access with less drama | BA being hard but helpful | Being less prioritized |
Saving yourself from impulses to self-harm | Feeling free and independent | |
Reducing the burden on loved ones |
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Lindkvist, R.-M.; Westling, S.; Eberhard, S.; Johansson, B.A.; Rask, O.; Landgren, K. ‘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. Int. J. Environ. Res. Public Health 2022, 19, 300. https://doi.org/10.3390/ijerph19010300
Lindkvist R-M, Westling S, Eberhard S, Johansson BA, Rask O, Landgren K. ‘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. International Journal of Environmental Research and Public Health. 2022; 19(1):300. https://doi.org/10.3390/ijerph19010300
Chicago/Turabian StyleLindkvist, Rose-Marie, Sofie Westling, Sophia Eberhard, Björn Axel Johansson, Olof Rask, and Kajsa Landgren. 2022. "‘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" International Journal of Environmental Research and Public Health 19, no. 1: 300. https://doi.org/10.3390/ijerph19010300