Feeling safe with patient-controlled admissions: A grounded theory study of the mental health patients' experiences

Aim: To develop a grounded theory of the patients' experiences with patient-controlled admission. Background: Research indicates a potential for involving patients in mental health care, but there is a need to develop and investigate new approaches in health services. Patient-controlled admission is an option for patients with severe mental disorders to refer themselves for a brief hospital admission when needed and thus avoid the usual admission procedure. Design: Classic grounded theory with generation of a theory based on the constant comparative method for data collection and analysis. Methods: Field observations and interviews with 26 mental health patients. The COREQ checklist was followed. Results: We found that patient-controlled admission induced safety by providing faster access to help and thus preventing further deterioration of symptoms. Being self-determined, achieving calmness and receiving care with support and guidance from professionals during admission contributed to the sense of safety. The familiarity with the mental health professionals in their related units supported the patients in managing their situation. On the other hand, feelings of being overlooked by the professionals and experiencing uncertainty could undermine patients' feeling of safety. Conclusions: We demonstrate that safety is a focal point for patients when receiving help and support in mental health care. Patient-controlled admission can induce a feeling of safety both at the hospital and at home. Patients' self-determination is strengthened, and brief admissions give them an opportunity to handle what they are currently struggling with. Professionals can support patients in this, but their actions can also reduce patients’ feeling of safety. Relevance to clinical practice: Patient involvement can be introduced in psychiatry, and even severely ill patients seem to be able to assess their own condition. Feasibility may, however, be associated with the attitude and behaviour of the professionals in clinical practice.