Torleif Ruud

• Maybery, Darryl; Davidson, Gavin; Grant, Anne; Piché, Geneviève; Yates, Scott & Ruud, Torleif [Show all 11 contributors for this article] (2026). Establishing research and translation priorities and care pathways for families where a parent lives with mental ill health. PLOS Mental Health. 3(6 June). doi: 10.1371/journal.pmen.0000266. Full text in Research Archive
• Larsen, Stine; Benth, Jurate Saltyte; Høifødt, Tordis Sørensen; Ruud, Torleif & Høye, Anne (2026). Effect of an implementation support program aimed at an evidence-based physical healthcare model for patients with severe mental illness. BMC Psychiatry. 26(1). doi: 10.1186/s12888-026-08261-0. Full text in Research Archive
• Skaare-Fatland, Klara; Hermann, Monica; Hartveit, Miriam; Assmus, Jørg; Drivenes, Karin & Ruud, Torleif [Show all 10 contributors for this article] (2026). Predictors of Beliefs About Medicines in Patients with Psychotic Disorders–A Longitudinal Observational Study in Mental Health Services. Patient Preference and Adherence. 20, p. 1–16. doi: 10.2147/PPA.S619321. Full text in Research Archive Show summary

  Purpose: Patients’ necessity beliefs and concerns about antipsychotic medication may influence medication adherence. This study aimed to identify factors predicting necessity beliefs and concerns about antipsychotic medication. Patients and Methods: This longitudinal study included patients with psychotic disorders from 31 Norwegian specialist mental health care units at baseline (0 months; N=310) and 12 months (n=151), reflecting attrition. We investigated associations between patients’ sociodemographic and clinical characteristics, their perceptions of medication support (MedSupport questionnaire), and their medication necessity beliefs and concerns (Beliefs about Medicines Questionnaire; BMQ) at baseline. We assessed change in BMQ subscales from baseline to 12 months and factors associated with the change. The data were analyzed using linear mixed-effects models. Results: At baseline, higher MedSupport scores were associated with higher BMQ-Necessity (β=0.18 (95% confidence interval (CI)=0.04 to 0.33)) and lower BMQ-Concerns (β=– 0.29 (95% CI=– 0.42 to – 0.16)) subscales. Higher educational level and higher number of psychotropic medications were associated with higher BMQ-Necessity. Higher symptom load and medication side effects were associated with higher BMQ-Concerns. Patients’ beliefs about their medications became more negative over time, ie BMQ-Necessity scores decreased (– 0.35 (95% CI=– 0.60 to – 0.11)) and BMQ-Concerns increased (0.25 (95% CI=0.05 to 0.45)). Higher dose of psychotropic medications at baseline and female sex was associated with an increase in BMQ-Necessity. A higher number of antipsychotic medications was associated with an increase in BMQ-Concerns from baseline to 12 months. Conclusion: Patients who experienced better medication support had significantly more positive medication beliefs at study start. Patients’ views about their medications became significantly more negative over the one-year follow-up, highlighting the potential need for clinicians to provide follow-up support to address the doubts and concerns that might emerge over the course of treatment.

• Skaare-Fatland, Klara; Hermann, Monica; Hartveit, Miriam; Ruud, Torleif; Drivenes, Karin & Biringer, Eva Kristin Hope Aaker (2026). ‘Are we doing it right?’–insights from a Norwegian multicentre study on antipsychotic management of psychotic disorders. Nordic Journal of Psychiatry. ISSN 0803-9488. 80(4), p. 226–234. doi: 10.1080/08039488.2026.2653983. Full text in Research Archive Show summary

  Introduction Knowledge about how medication management in the treatment of psychosis aligns with guideline recommendations is limited. This study aimed to investigate the extent to which current antipsychotic medication management adheres to guideline recommendations for the treatment of psychotic disorders in specialist mental healthcare in Norway. Methods Antipsychotic medication management was assessed using 44 criteria from the Antipsychotic Medication Management Fidelity Scale in Norwegian public mental health specialist units. The scale measures adherence (fidelity) to core components of medication management, as recommended in guidelines, at both unit level (N = 16 units) and patient level (N = 147 patient records). Results At the unit level, the mean fulfilment of criteria for maintaining a list of current medications and for systematic monitoring of side-effects were 8.8 (55%) and 5.5 (34%) units, respectively. At the patient level, lists of medications and doses were systematically updated in 112 (76%) patient records. The choice of antipsychotic medication and dosage was in accordance with the guidelines in 79 (54%) and 69 (47%) patient records, respectively. Mean fulfilment of criteria for monitoring and reducing side-effects was 42.8 (29%) patient records. Systematic monitoring of symptoms was not documented in any patient record. Conclusions Our study found structural and procedural shortcomings in medication management for psychosis in specialist mental healthcare. Low adherence to guidelines poses a significant patient safety risk. Addressing the implementation of clinical guidelines is essential to improve patient outcomes and the quality of care in specialist mental health services.

• Ruud, Torleif; Benth, Jurate Saltyte; Hussain, Ajmal; Rugkåsa, Jorun; Dahli, Mina Piiksi & Hanssen-Bauer, Ketil [Show all 11 contributors for this article] (2026). Effects of collaborative care on recognition and management of common mental disorders by general practitioners: a cluster-randomised trial in Norway. BMC Primary Care. 27(1). doi: 10.1186/s12875-026-03227-3. Full text in Research Archive
• Ruud, Torleif; Drake, Robert E.; Selle, Maria Lie; Hartveit, Miriam; Drivenes, Karin & Heiervang, Kristin Sverdvik [Show all 16 contributors for this article] (2026). Sustainment of Four Evidence-Based Treatments for Patients with Psychosis: A Prospective Cohort Study in Norway. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-026-01493-y. Full text in Research Archive Show summary

  Research on sustainment of implemented evidence-based practices (EBPs) for people with psychosis has been limited in mental health services. This prospective cohort study extended a cluster-randomized trial (trial registration number NCT03271242) of implementation of four EBPs in Norwegian mental health services. In the trial 39 clinical units were randomized to receive implementation support for one of two chosen EBPs. This study aimed to measure sustainment for two biological EBPs (physical health care, antipsychotic medication management) and two psychosocial EBPs (family psychoeducation, illness management and recovery), and to explore factors influencing sustainment. Fidelity to the EBP with implementation support was measured after 18 months of implementation support and at 36 months (18 months post-implementation), additionally key informants reported factors influencing sustainment. Among 27 sites with high or moderate fidelity at 18 months, 20 (74%) sustained the practice at the same or higher level at 36 months; 10 of 13 sites, most with psychosocial EBPs, sustained high fidelity, and 10 of 14 sites, most with biological EBPs, sustained moderate fidelity. Sustaining sites demonstrated significantly greater efforts to continue the EBP, while non-sustaining sites encountered greater barriers including leadership change or key clinician turnover. With efforts to continue the EBP, most sites sustained the practice with high fidelity for psychosocial EBPs and moderate fidelity for biological practices. A clinical director or champion determined to continue the practice together with a trained clinical staff were the two main ingredients for sustainment.

• Ruud, Torleif; Karlsson, Bengt Eirik; Klevan, Trude & Hasselberg, Nina (2026). Organisation and Practice of Crisis Resolution Teams in Adult Mental Health Services in Norway: A National Survey. International Journal of Mental Health Nursing. ISSN 1445-8330. 35(1). doi: 10.1111/inm.70238. Full text in Research Archive Show summary

  ABSTRACT Crisis resolution teams (CRTs), which aim to reduce acute admissions to mental health inpatient units, have been the subject of studies on practice, effects and service user experiences. However, such studies involve a limited proportion of the CRTs. National surveys are necessary to understand the large‐scale implementation of CRTs. The aims of this survey were to describe the organisation and practices of Norwegian CRTs as reported by team managers. An online questionnaire was sent to team managers of all 56 CRTs in mental health services for adults in Norway in 2013. The response rate was 100%. Findings were compared to national recommendations for CRTs in Norway and to findings from a similar survey in England. CRTs were available for 90% of the Norwegian adult population. Significant variations in team composition and practices indicated differences in CRT services provided across teams, and CRTs were not assigned the role of gatekeeping acute inpatient admissions. Unlike in England, Norwegian CRTs served a broader range of service users than just those who would otherwise require admission to an acute mental health inpatient unit. CRTs showed partial adherence to national recommendations and even less compared to English CRTs and the CRT model in international literature. High adherence to the CRT model would require more specific national recommendations, adequate staffing and training, and for CRTs to be given the resources and authority to act as gatekeepers for acute inpatient admissions.

• Norheim, Irene; Pedersen, Reidar; Selle, Maria Lie; Røssberg, Jan Ivar; Hestmark, Lars & Heiervang, Kristin Sverdvik [Show all 13 contributors for this article] (2025). Effectiveness of implementing family involvement on patient outcomes in individuals with psychotic disorders: a pragmatic cluster randomised controlled trial. BMC Psychiatry. 25(1). doi: 10.1186/s12888-025-07501-z. Full text in Research Archive Show summary

  Abstract Background The purpose of this sub-study, as part of the Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, was to examine the effectiveness of family interventions (FIs) implemented through an implementation support program (ISP) on patients’ outcomes. Methods The IFIP trial is a cluster randomised controlled trial where 15 Community Mental Health Centre units were randomly allocated either to the ISP, which included FIs as clinical interventions, implementation strategies, and implementation interventions, or to treatment as usual (TAU). In the control arm, patients could have access to FIs. Patients with psychotic disorders in both arms were asked to complete questionnaires at inclusion, 6- and 12 months. The primary outcome was patients’ difficulties in interpersonal relationships measured with the Relationships subscale of Behaviour and Symptom Identification scale. The secondary outcomes were patients’ mental health and functioning, perceived expressed emotions, recovery, and quality of life. Linear mixed-effects models were used to analyse differences in change over time between the two arms. Results We included 231 patients (135 from the intervention units; 96 from the control units). Except for the first 24% of the 6 months questionnaires, the 6- and 12-month data were collected during the COVID-19 pandemic. There were no significant differences in the primary outcome, difficulties in interpersonal relationships at 12 months, between the intervention and control arms (Cohen’s d = -0.19, p  = 0.2). The secondary outcomes showed less perceived criticism from the relatives (Perceived Criticism sub-score; d = − 0.4, p  = 0.01) and reduced difficulties in overall functioning (Health of the Nation Outcome Scale; d = − 0.29, p  = 0.01) in the intervention arm compared to the control arm at 12 months. Conclusion The FIs, implemented through the ISP, did not achieve significant decreases in patients’ difficulties with interpersonal relationships. However, this sub-study indicates that FIs in routine mental health practices can nurture a more positive family environment and enhance the patient’s process toward improved functioning. The complexity of the study design, and the restrictions due to COVID-19, may have diminished the implementation and effectiveness of the measured FIs for the patients. Trial registration ClinicalTrials.gov Identifier NCT03869177. Registered 2019-02-28.

• Ruud, Torleif; Rugkåsa, Jorun; Haavet, Ole Rikard; Dahli, Mina Piiksi; Hanssen-Bauer, Ketil & Brekke, Mette [Show all 9 contributors for this article] (2025). A collaborative primary and mental health care model with psychologist and psychiatrist working in GP practices: process evaluation of the implementation, challenges, and sustainability. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-13408-y. Full text in Research Archive
• Fröding, Regina; Clausen, Hanne Kristin; Marciuch, Anne; Ruud, Torleif; Benth, Jurate Saltyte & Veland, Mina [Show all 7 contributors for this article] (2025). The roles of stress, illness management, and goal setting on the association between personal and clinical recovery – a prospective study. BMC Psychiatry. 25(1). doi: 10.1186/s12888-025-07291-4. Full text in Research Archive Show summary

  Background Investigating underlying working mechanisms involved in the relationship between personal and clinical recovery is important for enhancing mental health treatment. This prospective study investigated the impact of two anticipated moderators, 1) receiving help with managing stress and illness, and 2) receiving help with setting and achieving goals, on the association between personal and clinical recovery at baseline and 18-month follow-up among service users with psychosis. Methods Data were collected from service users with psychosis and their clinicians from 32 clinical sites across Norway at baseline (n = 318) and after 18 months (n = 121). Personal recovery was measured using the Questionnaire about the Process of Recovery. Linear mixed models were estimated to assess the impact of the two moderators on the association between personal and clinical recovery. Results Service users with higher level of symptoms at baseline who stated that they received help with setting and achieving goals showed greater personal recovery over 18 months compared to those who stated that they did not receive this help. Service users with low level of functioning who stated that they received help with managing stress and illness or setting and achieving goals experienced higher levels of personal recovery than did those who stated that they did not receive this help. Conclusion Receiving help with managing stress and illness and receiving help with setting and achieving goals, have an impact on personal recovery for service users with low levels of functioning and/or higher levels of symptoms. It might be beneficial to incorporate these aspects into treatments aimed at increasing personal recovery.

• Ruud, Torleif; Benth, Jurate Saltyte; Biringer, Eva Aaker; Hartveit, Miriam; Drivenes, Karin & Heiervang, Kristin Sverdvik [Show all 15 contributors for this article] (2025). A secondary exploratory study of associations between patient- and clinician-reported clinical outcomes and fidelity for four evidence-based psychosis treatments. BMC Psychiatry. 25(1), p. 1–13. doi: 10.1186/s12888-025-07566-w. Full text in Research Archive Show summary

  Background Implementation of evidence-based practices (EBPs), measured as fidelity to the EBP model, is generally expected to yield significant positive clinical outcomes. However, this association has only partially been established for EBPs used in psychosis treatment. From a cluster-randomized controlled trial (CRCT), we previously reported on the effects of implementation support for four EBPs for psychosis, using fidelity as the measure of implementation success. The current secondary, exploratory study used data from the non-blinded CRCT parent study to investigate the associations between patient- and clinician-reported outcomes and fidelity for these four EBPs. Methods Clinical outcomes were measured in a cohort of 325 patients over three six-month periods. Primary outcomes were BASIS-24 (patient-reported) and HoNOS (clinician-reported). Secondary outcomes were selected subscales of these two measures. The EBPs were Physical Health Care, Antipsychotic Medication Management, Family Psychoeducation, and Illness Management and Recovery. In the CRCT, each of 39 clinical units across six health trusts selected two EBPs for implementation. Units were randomized to the intervention group (implementation support) for one EBP and the control group (written manual) for the other. Fidelity of the four EBPs was measured at baseline and every six months for 18 months. We analyzed the associations between outcomes and fidelity using linear mixed models. Results BASIS-24 and HoNOS showed improvements for the total sample at 6 and 12 months, and two patient-reported subscales, Symptoms and Relationships, showed improvement at 6 months within two different EBP subsamples. However, no positive associations were found between secondary outcomes and EBP fidelity. Conclusions Despite some improvements in primary and secondary outcomes over the first 6 to 12 months, we found no positive associations between outcomes and fidelity. Sample size, attrition, trial design, variance in variables, measurement properties, and low exposure, as well as interaction between such factors, might have contributed to our failure to find positive associations between outcomes and fidelity. Future studies of the association between outcomes and fidelity should involve large samples, use outcome and exposure measures closely related to the EBPs, and track cohorts from the beginning of treatment. Trial registrations ClinicalTrials NCT03271242, retrospectively registered 31 August 2017.

• Holgersen, Katrine Høyer; Hasselberg, Nina; Siqveland, Johan & Ruud, Torleif (2025). Effect of crisis resolution team treatment on crisis experience and crisis coping: a multicenter pre-post study in Norway. BMC Psychiatry. 25(1). doi: 10.1186/s12888-025-07491-y. Full text in Research Archive Show summary

  Abstract Background Crisis resolution teams (CRTs) have been established in several high-income countries to improve access to mental health services and to prevent unnecessary inpatient admissions. General crisis theory is one of the foundations underpinning the development of CRTs. However, little research has been conducted on what characterises the situations leading to contact with these services and the crisis reactions during CRT care. This study aimed to describe characteristics and situations leading to contact with CRTs and to explore and predict possible changes in crisis experience and coping after CRT treatment. Methods Participants of this Norwegian multicentre pre-post study included 546 CRT service users of 25 CRTs. No control group was included. The present study builds on data collected from service users and team workers. The main outcome variables were change in patient-reported crisis experience and crisis coping from start to end of treatment. We performed descriptive analysis of affected life domains, and linear mixed modelling to analyse how outcomes were associated with patients’ characteristics and treatment. Results At treatment initiation, service users reported high scores of crisis experience and coping difficulties. Several life domains were affected, particularly emotional-life domains, such as mental illness, suicide risk, and loneliness. Lower levels of crisis experience, and enhanced coping abilities were observed within a timeframe of eight weeks or less. Although the current study design cannot rule out a specific causal relationship, recovery was nevertheless associated with service satisfaction, practical support, medication management, and quick access to help. Psychiatric symptoms at start, previous mental illness, and collaboration with wards were negatively related to a favourable outcome. Conclusions CRT service users reported high levels of crisis experience and low levels of coping at treatment initiation. CRT treatment was associated with a decrease in severity and improvement in coping, although more severe mental health problems at the start were negatively related to recovery.

• Fröding, Regina; Clausen, Hanne Kristin; Ruud, Torleif; Benth, Jurate Saltyte; Veland, Mina & Heiervang, Kristin Sverdvik (2025). The Relationship Between Personal Recovery, Clinical Symptoms, and Psychosocial Functioning Over Time Among Service Users With Psychosis. Psychiatric rehabilitation journal. ISSN 1095-158X. 48(1), p. 23–31. doi: 10.1037/prj0000635. Full text in Research Archive Show summary

  Objective: Longitudinal investigation of associations between personal and clinical recovery is important to understand how the relationship unfolds over time. This prospective study investigated associations between personal recovery and clinical symptoms, and personal recovery and psychosocial functioning, at baseline and 18-month follow-up, among service users with psychosis. Method: Data were collected from 318 service users with psychosis and their clinicians from 32 clinical sites across Norway at baseline and after 18 months. Personal recovery was measured using the Questionnaire About the Process of Recovery. Linear mixed models with random intercepts for units were estimated to test the association between personal recovery and clinical symptoms, and personal recovery and psychosocial functioning. Results: Greater severity of symptoms and lower level of functioning were associated with lower personal recovery assessed at both baseline and follow-up. Greater severity of symptoms and lower level of functioning measured at baseline predicted lower personal recovery at follow-up. In addition, personal recovery decreased over time for those with a greater severity of symptoms but increased over time for those with a high level of functioning. Conclusions and Implications for Practice: Overall, this study confirms the relationship between clinical recovery and personal recovery. Both clinical symptoms and level of functioning were associated with personal recovery, indicating that both aspects are important for personal recovery. These findings suggest that it might be beneficial to support both clinical and personal recovery in the treatment of people with psychosis.

• Maybery, Darryl; Grant, Anne; Piché, Geneviève; Yates, Scott; Ruud, Torleif & Dunkley-Smith, Addy [Show all 7 contributors for this article] (2024). Summarising Quantitative Outcomes in Parental Mental Illness Research. International Journal of Mental Health Nursing. ISSN 1445-8330. 33(6), p. 1761–1795. doi: 10.1111/inm.13385. Full text in Research Archive Show summary

  A quarter of all children grow up in a family where a parent experiences a mental illness (FaPMI). Research activity in this area is growing rapidly and it is now critical to better understand the extant knowledge in the field. This scoping review of quantitative FaPMI literature parallels a qualitative literature review and a series of Delphi studies with key stakeholders (e.g. lived experience and clinicians), that is part of a larger program of research to achieve consensus regarding the direction of FaPMI research; including making recommendations about outcomes and measures. The programme of research aims to promote and facilitate greater comparison and learning across studies and settings. Initially this scoping review summarises the quality and focus (e.g. country and sampling) of 50 quantitative studies from 2000 to 2023 and then classifies studies according to outcomes for parents, children and families. Six to eleven years were the most common child sample group and girls were slightly underrepresented (49/51) and parents were 88% mothers. Analogous parent and child outcomes were; mental illness/psychopathology, wellbeing, mental health literacy, trauma and stressful experiences, coping, help seeking/service need, within family relationships and supports, outside family relationships and supports. Additional outcomes for parents were; parenting skills, parent competence and parenting stress and for children in relation to their; cognitive functioning and caregiving. The family related outcomes were the within and outside family relationships and supports. Since 2000 there have been 136 different survey instruments employed with approximately 80% used in only one study. This suggests that the broader goals of the program of research are warranted as there is a need for less heterogeneity in measures used. Suggested areas for future research include a sampling focus on fathers, economic evaluations of programs, parent mental health literacy, trauma, genetics and integrating well-being concepts into research designs. Child research should focus on mental health literacy, the level and impact of caring responsibilities, assessing past trauma and the roles of close family and external supports.

• Clausen, Hanne Kristin & Ruud, Torleif (2024). The Practical and Social Functioning (PSF) scale: development and measurement properties of an instrument for assessing activity and social participation among people with serious mental illness. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-06135-x. Full text in Research Archive Show summary

  Background: Participation in society and the ability to perform various activities are crucial aspects of everyday functioning. The intertwined relationship between functioning, disability, and health is emphasized in the "International Classification of Functioning, Disability and Health (ICF)" framework. In recent decades, mental health care units have increasingly focused on this aspect. The Practical and Social Functioning scale (PSF) was developed and validated in Norwegian as an easy-to-administer instrument to assess practical and social functioning among patients with serious mental illness in different clinical settings. Methods: The PSF was developed and revised using data from different Norwegian studies. Data from a total of 562 patients with serious mental illness in different clinical settings were included. The validation process included the evaluation of items into categories by 25 professionals. Development and revision took place in three different stages, and factor analyses were conducted. The quality of the PSF was assessed according to the COSMIN standards for systematic reviews on patient-reported outcome measures. Results: The final version of the PSF comprises seven subscales, each consisting of four items, resulting in a total of 28 items. These subscales, along with their corresponding items, are loaded onto two factors representing the main dimensions of functioning: activity and participation. Content validity comprises three domains: relevance, comprehensiveness, and comprehensibility. Relevance and comprehensibility were found to be adequate, whereas comprehensiveness was doubtful. Structural validity was adequate, internal consistency was very good, and construct validity was adequate compared to the Global Assessment of Functioning scale. Responsiveness was found to be doubtful in our study with data from an 18-month observation period. Nearly 60% of the items showed a ceiling effect. No items showed a floor effect. Conclusion: The development and validation of the Norwegian version of the PSF resulted in an instrument consisting of seven subscales and a total of 28 items. The items and subscales assess functioning related to two key factors according to the ICF framework: activity and participation. Our results show that the PSF is an easy-to-administer instrument that may be particularly sensitive for detecting variation among persons with severely impaired functioning.

• Nordin, Håkan; Mathisen, Gro Ellen; Rørtveit, Kristine; Joa, Inge; Johannessen, Jan Olav & Ruud, Torleif [Show all 7 contributors for this article] (2024). Implementing Clinical Guidelines for the Treatment of Psychosis: The Frontline Leaders’ Point of View. A Qualitative Study. Journal of Healthcare Leadership. 16, p. 93–104. doi: 10.2147/JHL.S430285. Full text in Research Archive Show summary

  Background: Despite the large amount of leadership and implementation theories and recommendations, healthcare services continue to struggle with efficiently incorporating new knowledge. The questioning of conventional leadership approaches in healthcare organizations prompted us to investigate how frontline leaders comprehend their own implementation intentions and actions, and how these intentions and actions may impact the implementation of clinical guidelines in mental healthcare in Norway. Methods: Employing a theory-driven qualitative design, we conducted nine semi-structured interviews with frontline leaders who had recently led implementation of clinical guidelines for the treatment of psychosis in mental health. We employed Systematic Text Condensation, informed by Normalization Process Theory, to structure and analyze the data and used fidelity scales to measure the degree of implementation and distinguish between leaders’ levels of success in implementation. Results: Frontline leaders in units that achieved high success in implementation described their intentions and actions differently, from those with less success. The former group’s actions aligned more closely with the constructs of the Normalization Process Theory compared to the latter group when describing their actions. Frontline leaders leading units with a high degree of implementation success describe relation-orientation, trust, and providing adaptive space for staff members to take initiative. In contrast, those leading units with less implementation success describe more control and guidance of co-operators and place more emphasize on information and knowledge. Conclusion: Differences in how frontline leaders describe their actions and intentions to achieve clinical guideline implementation suggest that the leadership approach of these frontline leaders is an important factor to consider when planning and conducting implementation. To better understand the implementation process, it is important to pay attention to how frontline leaders customize their leadership approaches to the dynamics of complex organizations, and how they interact with their team and superiors.

• Norheim, Irene; Pedersen, Reidar; Selle, Maria; Røssberg, Jan Ivar; Hestmark, Lars & Heiervang, Kristin Sverdvik [Show all 12 contributors for this article] (2024). Implementation of guidelines on Family Involvement for persons with Psychotic disorders: a pragmatic cluster randomized trial. Effect on relatives’ outcomes and family interventions received. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1381007. Full text in Research Archive Show summary

  Background: Family interventions (FI) are recommended as part of the treatment for psychotic disorders, but the implementation in mental health services is generally poor. Recently, The Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, demonstrated significant improvements in implementation outcomes at cluster-level. This sub-study aims to examine the effectiveness of the IFIP intervention on relatives’ outcomes and received FI. Methods: A cluster randomized controlled trial, was conducted in 15 Norwegian Community Mental Health Center (CMHC) units that were randomized to either the IFIP intervention, including implementation interventions and clinical interventions, or treatment as usual (TAU). The clinical interventions consisted of FI: basic family involvement and support (BFIS) to all patients and family psychoeducation (FPE) to as many as possible. Patients with psychotic disorders and their closest relative were invited to fill in questionnaires at inclusion and 6 months and 12 months follow-up. Received FI was reported by both relatives and clinicians. The relatives’ primary outcome was satisfaction with health service support, measured by the Carer well-being and support questionnaire part B (CWS-B). The relatives’ secondary outcomes were caregiver experiences, expressed emotions and quality of life. Patients’ outcomes will be reported elsewhere. Results: In total 231 patient/relative pairs from the CMHC units were included (135 intervention; 96 control).The relatives in the intervention arm received an increased level of BFIS (p=.007) and FPE (p < 0.05) compared to the relatives in the control arm, including involvement in crisis planning. The primary outcome for relatives’ satisfaction with health service support, showed a non-significant improvement (Cohen’s d = 0.22, p = 0.08). Relatives experienced a significant reduced level of patient dependency (Cohen’s d = -0.23, p = 0.03). Conclusion: The increased support from clinicians throughout FI reduced the relatives’ perceived level of patient dependency, and may have relieved the experience of responsibility and caregiver burden. The COVID-19 pandemic and the complex and pioneering study design have weakened the effectiveness of the IFIP intervention, underscoring possible potentials for further improvement in relatives’ outcomes. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03869177.

• Skar-Fröding, Regina; Clausen, Hanne Kristin; Biringer, Eva Aaker; Ruud, Torleif; Benth, Jurate Saltyte & Veland, Mina [Show all 7 contributors for this article] (2024). Service and Treatment Factors as Predictors of Satisfaction with Mental Health Services Among Service Users with Psychosis. Community mental health journal. ISSN 0010-3853. doi: 10.1007/s10597-024-01418-9. Full text in Research Archive Show summary

  Satisfaction with services among service users is an important aspect of quality in mental health care. This prospective study investigated associations between service and treatment factors at baseline and satisfaction with services at 18-month follow-up among service users with psychosis in specialist mental health services. Data were collected from 119 service users with psychosis and their clinicians from 26 clinical sites across Norway at baseline and after 18 months. Satisfaction with services was measured using the Client Satisfaction Questionnaire-8 (CSQ-8). Linear mixed models with random intercepts for units were estimated to test the association between service- and treatment-related predictors and the CSQ-8. Participating in the Individual Placement and Support program or other interventions to promote work or study, receiving well-coordinated services, and receiving helpful assistance from a general practitioner at baseline were positively associated with satisfaction with services at 18-month follow-up. The present results suggest that receiving integrated and well-coordinated services and targeting the goal of facilitating employment and study opportunities is important for satisfaction with services among service users with psychosis.

• Ruud, Torleif; Hasselberg, Nina Eide; Siqveland, Johan & Holgersen, Katrine Høyer (2024). Patient-reported outcome, clinician-reported outcome, and patient satisfaction with treatment by crisis resolution teams: a multicenter pre-post study of outcome and associated factors in Norway. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05543-3. Full text in Research Archive Show summary

  Background: Crisis resolution teams (CRTs) have become a part of mental health services in many high-income countries. Many studies have investigated the impact of CRTs on acute admissions to inpatient units, but very few studies have investigated patient-reported and clinician-reported outcomes for CRT service users. Our aims were to study patient-reported and clinician-reported outcomes of CRT treatment, how the outcomes were associated with characteristics of the service user and the treatment, and whether outcomes were different across CRTs. Methods: The study was a pre-post observational multicenter study of 475 patients receiving treatment from 25 CRTs in urban and rural areas in Norway. There was no control group. Outcomes were change in mental health status reported by service users using CORE-10 and by clinicians using HoNOS. Patient satisfaction was measured using CSQ-8 at the end of the treatment. Components of CRT accessibility and interventions were measured by clinicians reporting details on each session with the service user. CRT model fidelity was measured using the CORE CRT Fidelity Scale version 2. We used paired t-tests to analyze outcomes and linear mixed modeling to analyze associations of the outcomes with the characteristics of service users and the treatment provided. Using independent t-tests, we analyzed differences in outcomes and patient satisfaction between two clusters of CRTs with differences in accessibility. Results: The patient-reported outcomes and the clinician-reported outcomes were significantly positive and with a large effect size. Both were significantly positively associated with practical support and medication management and negatively associated with collaboration with mental health inpatient units. Patient satisfaction was high at the end of the treatment. CRTs with higher accessibility had a significantly better clinician-reported outcome, but no significant differences were reported for patient-reported outcomes or patient satisfaction. Conclusions: CRT treatment led to improved symptom status as reported by patients and clinicians, as well as high patient satisfaction. Practical support and medication management were the interventions most strongly associated with positive outcomes. Some of the variations in outcomes were at the team level. Patient- and clinician-reported outcomes should be used more in studies on the effect of treatment provided by crisis resolution teams.

• Ruud, Torleif; Selle, Maria; Clausen, Hanne Kristin; Heiervang, Kristin Sverdvik; Odden, Sigrun & Stuen, Hanne Kilen [Show all 7 contributors for this article] (2024). Clinical outcomes and outcome predictors of two-year assertive community treatment in Norway: an explorative prospective pre–post study. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-06181-5. Full text in Research Archive Show summary

  Background Assertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams. Methods Our explorative, prospective, pre–post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment. Results After two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team’s fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start. Conclusions ACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams.

• Stavnes, Kristin Anne; Ruud, Torleif; Benth, Jurate Saltyte; Hanssen-Bauer, Ketil; Solantaus, Tytti & Hilsen, Marit [Show all 10 contributors for this article] (2023). Norwegian health personnel’s contacts and referrals for children of ill parents: an exploratory cross-sectional multi-centre study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09607-0. Full text in Research Archive Show summary

  Background In 2010, changes were made to the Norwegian Health Personnel Act. This led to all health personnel being obliged to support the patients’ children and families. The aims of this study were to investigate whether health personnel contacted or referred the patients’ children to family/friends or public services. We also investigated if there were factors in the family or the services that increased or decreased the degree of contacts and referrals. In addition the patients were asked whether the law had been a help or even a burden. This study was part of a larger multi-site study of children of ill parents conducted in fve health trusts in Norway. Method We used cross-sectional data from 518 patients and 278 health personnel. The informants completed a questionnaire addressing the law. Data were analyzed by factor analysis and logistic regression. Results The health personnel contacted/referred children to diferent services, but not to the degree desired by their parents. Only a few contacted family/friends, or the school and/or the public health nurse, those representing the helpers who live closest to the child, and thus well situated to participate in help and preventive eforts. The service most often referred to was the child welfare service. Conclusion The results indicate a change in contacts/referrals for children from their parents’ health personnel but also reveal remaining needs for support/help for these children. Health personnel should strive to write more refer‑ rals and take more contacts than the current study suggests, to secure adequate support for children of ill parents in Norway, as intended in The Health Personnel Act.

• Haune, Monica Christine; Nissen, Alexander; Christiansen, Øivin; Myrvold, Trine; Ruud, Torleif & Heiervang, Einar Røshol (2023). Comprehensive Health Assessment for Children in Out-of-Home Care: An Exploratory Study of Service Needs and Mental Health in a Norwegian Population. Child Psychiatry and Human Development. ISSN 0009-398X. doi: 10.1007/s10578-023-01619-5. Full text in Research Archive Show summary

  A comprehensive model for routine multi-disciplinary health assessment for children in out-of-home care was piloted in a Norwegian region. This paper reports on identified service needs and mental disorders among 196 children (0–17 years) receiving the assessment. Cross-sectional data was extracted from assessment reports. Results show needs across a range of services, with a mean of 2.8 recommended services for children aged 0–6 and 3.3 for children aged 7–17. Mental disorders were identified in 50% of younger children, and 70% of older children. For all children, overall service need was associated with mental disorders, in addition to male gender among younger children. Need for specialized mental health services was associated with mental disorders among younger children and increasing age among older children. The high frequency of service needs and mental disorders illustrate the importance of offering comprehensive health assessments routinely to this high-risk child population and necessitates coordinated service delivery.

• Husum, Tonje Lossius; Siqveland, Johan; Ruud, Torleif & Lickiewicz, Jakub (2023). Systematic literature review of the use of Staff Attitudes to Coercion Scale (SACS). Frontiers in Psychiatry. 14. doi: 10.3389/fpsyt.2023.1063276. Full text in Research Archive Show summary

  Objective: Staff’s attitudes to the use of coercion may influence the number of coercive interventions employed and staff willingness to engage in professional development projects aimed at reducing the use of coercion itself. The Staff Attitude to Coercion Scale (SACS) was developed to assess the attitudes of mental healthcare staff to the use of coercion in 2008 and has been employed subsequently. This global study systematically reviews and summarizes the use of the scale in research. Methods: Seven databases were searched for studies using SACS in articles published in peer reviewed journals and gray literature. In addition, researchers who have asked for permission to use the scale since its development in 2008 were contacted and asked for their possible results. Extracting of data from the papers were performed in pairs of the authors. Results: Of the 82 identified publications, 26 papers with 5,838 respondents were selected for review. A review of the research questions used in the studies showed that the SACS questionnaire was mostly used in studies of interventions aimed at reducing coercion and further explain variation in the use of coercion. Conclusion: SACS is, to our best of knowledge, the only questionnaire measuring staff’s attitudes to the use of coercive interventions in mental health services. Its widespread use indicates that the questionnaire is perceived as feasible and useful as well as demonstrating the need for such a tool. However, further research is needed as the relationship between staff attitudes to coercion and the actual use of coercion remains unclear and needs to be further investigated. Staff attitudes to coercion may be a prerequisite for leaders and staff in mental healthcare to engage in service development and quality improvement projects.

• Ruud, Torleif; Fjellestad, Ingrid Kyte & Hanssen-Bauer, Ketil (2023). Patient experiences in psychiatric departments for the elderly (PEPDE): development, properties, and use of a brief questionnaire. BMC Psychiatry. 23(1), p. 11–11. doi: 10.1186/s12888-023-04633-y. Full text in Research Archive Show summary

  Background Measuring patient experiences at psychiatric inpatient departments for the elderly need measurements adapted to the situation and challenges of the age group. We did not find any such instrument. The aim of this study then was to develop and document the measurement properties of a reliable and valid questionnaire about experiences of patients without severe neurocognitive disturbances at psychiatric inpatient departments for the elderly, which can be used in quality improvement and research. Methods Aiming for good content validity, we developed a questionnaire with 37 questions based on a review of the literature on important aspects for the elderly in psychiatric inpatient departments and on feedback from elderly patients from other questionnaires developed for use in psychiatric departments for adults. Using this first questionnaire, we collected data from 151 patients in psychiatric departments for the elderly in nine health trusts. We then revised the questionnaire based on comments from patients and interviewers on the questions, and we decided which questions we would keep and which we needed to adjust to improve clarity. This resulted in a final questionnaire of 20 questions. We analyzed the internal structure (factors and their internal consistency) of this final questionnaire based on data collected from a new sample of 96 patients. To test the construct validity of the questionnaire, a sample of 26 service user representatives, clinicians and researchers were asked to sort the questions based on identified factors. Results The final questionnaire consisted of 20 questions giving a valid and reliable measurement tool with four subscales: Patient-centered Interaction, Outcome, Care and Safety, and Information on Rights. Very few unanswered questions indicate that the questionnaire is feasible, as patients seemed to understand the questions and the response scales well. It is desirable that structural validity is confirmed with a larger sample. Conclusion Our final questionnaire “Patient Experiences in Psychiatric Departments for the Elderly” (PEPDE) has adequate measurement properties and seems to be well understood. It can be used as a questionnaire or an interview for quality improvement and research.

• Israel, K Pravin; Ruud, Torleif & Weimand, Bente Margrethe (2023). Carer involvement in the assessment of personal recovery: A naturalistic study of assertive community treatment in Norway. Frontiers in Psychiatry. 14, p. 1–8. doi: 10.3389/fpsyt.2023.1135135. Full text in Research Archive Show summary

  Background: The user and carer movements have come a long way in becoming embedded in mainstream mental health services for individuals with serious mental illness. However, implementing recovery-oriented practice continues to be plagued by an individualistic clinical focus. The carers do not feel integrated despite policies and best intentions. The implementation of Assertive Community Treatment (ACT) provided an opportunity to involve the carers and compare their assessment of personal recovery with the users. Aims: The aims of this study were to examine (i) how family carers and users differed in their assessment of personal recovery, (ii) whether familial and personal relationships influenced how carers assess personal recovery of users, and (iii) if the experience of family carers with the ACT team was associated with personal recovery. Methods: The naturalistic, explorative study recruited 69 users and 36 family carers from 12 Norwegian ACT teams. The users and carers assessed the user’s personal recovery. Family carers also reported their experience and satisfaction with the ACT teams. Analyses included independent and paired sample T-tests and correlation analysis. Results: Family carers were significantly more conservative than the users’ assessment of the intrapsychic and interpersonal subscales of personal recovery. The pattern held true whether the family carers were matched to the users or part of the total sample. Lastly, there was a significant negative correlation between the family carer’s experience of cooperation with the ACT team and their assessment of the user’s intrapersonal process of recovery. Conclusions: The results of our study were consistent with previous research on carer involvement in MHS. However, it is the first study that engaged carers and assessed personal recovery of the users of ACT services. Discrepancy between carers and users is the rule. Clinicians are encouraged to embrace the discrepancy and diversity carers bring and learn the methodology of multi- informant assessments. There also is a need to address, update, and integrate the personal, familial, and relational aspects of recovery. Modification of recovery measures such as QPR and their creative use with carers has the potential to generate valuable third-party information and to involve them meaningfully in mental health services.

• Haugom, Espen Woldsengen; Benth, Jurate Saltyte; Stensrud, Bjørn; Ruud, Torleif; Clausen, Thomas & Landheim, Anne Signe (2023). Shared decision making and associated factors among patients with psychotic disorders: a cross-sectional study. BMC Psychiatry. 23(1). doi: 10.1186/s12888-023-05257-y. Full text in Research Archive Show summary

  Background: Shared decision making is a process where patients and clinicians collaborate to make treatment choices based on the patients' preferences and best available evidence. The implementation of shared decision making remains limited for patients with psychotic disorders despite being recommended at policy level, being advocated as ethical right and wanted by the patient's. A barrier to implementation that is often mentioned is reduced decision-making capacity among patients. The challenges of implementing shared decision making highlights a need for more knowledge on shared decision making for these patients. Moreover, the association between patient-related characteristics and shared decision making is unclear, and further research have been suggested. More knowledge of factors associated with involvement in shared decision making can enhance understanding and help to empower patients in the decision-making process. The current study examined the extent of reported shared decision making among patients with a psychotic disorder in mental health care and factors associated with shared decision making. Methods: This study included 305 participants with a psychotic disorder from 39 clinical inpatient and outpatient sites across Norway. Shared decision making was assessed using the CollaboRATE survey. A linear mixed model was estimated to assess characteristics associated with shared decision making scores. Results: The CollaboRATE mean score was 6.3 (ranging from 0 to 9), the top score was 14.1% and increased global satisfaction with services was significantly associated with a higher level of shared decision making (regression coefficient 0.27, 95% confidence interval (0.23; 0.32), p < 0.001). Conclusions: The low top score shows that few patients felt that they received the highest possible quality of shared decision making, indicating that many patients found room for improvement. This suggests that services for patients with psychotic disorders should be designed to give them a greater role in decision making. Shared decision making might play a key role in mental health care, ensuring that patients with psychotic disorders are satisfied with the services provided. Trial registration: NCT03271242, date of registration: 5 Sept. 2017.

• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin Sverdvik; Hansson, Kristiane Myckland; Ruud, Torleif & Benth, Jurate Saltyte [Show all 9 contributors for this article] (2023). Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 50(3), p. 520–533. doi: 10.1007/s10488-023-01255-0. Full text in Research Archive Show summary

  Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12–14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.

• Nordin, Håkan; Rørtveit, Kristine; Mathisen, Gro Ellen; Joa, Inge; Johannessen, Jan Olav & Ruud, Torleif [Show all 7 contributors for this article] (2022). Frontline leadership for implementing clinical guidelines in Norwegian mental health services: a qualitative study. Journal of Health Organisation and Management. ISSN 1477-7266. 36(5), p. 617–632. doi: 10.1108/JHOM-08-2021-0286. Full text in Research Archive
• Hansson, Kristiane Myckland; Romøren, Maria; Pedersen, Reidar; Weimand, Bente Margrethe; Hestmark, Lars & Norheim, Irene [Show all 9 contributors for this article] (2022). Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres - a nested qualitative study. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08489-y. Full text in Research Archive Show summary

  Background The uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders. Methods We performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis. Results Organisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals. Conclusions Implementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families.

• Hustoft, Kjetil; Larsen, Tor Ketil; Brønnick, Kolbjørn Kallesten; Joa, Inge; Johannessen, Jan Olav & Ruud, Torleif (2022). Psychiatric patients’ attitudes towards being hospitalized: a national multicentre study in Norway. BMC Psychiatry. 22, p. 1–8. doi: 10.1186/s12888-022-04362-8. Full text in Research Archive Show summary

  Background: The aim of the study was to explore patients’ attitudes towards voluntary and involuntary hospitalization in Norway, and predictors for involuntary patients who wanted admission. Methods: A multi-centre study of consecutively admitted patients to emergency psychiatric wards over a 3 months period in 2005–06. Data included demographics, admission status (voluntary / involuntary), symptom levels, and whether the patients expressed a wish to be admitted regardless of judicial status. To analyse predictors of wanting admission (binary variable), a generalized linear mixed modelling was conducted, using random intercepts for the site, and fixed effects for all variables, with logit link-function. Results: The sample comprised of 3.051 patients of witch 1.232 (40.4%) were being involuntary hospitalised. As expected 96.5% of the voluntary admitted patients wanted admission, while as many as 29.7% of the involuntary patients stated that they wanted the same. The involuntary patients wanting admission were less likely to be transported by police, had less aggression, hallucinations and delusions, more depressed mood, less use of drugs, less suicidality before admission, better social functioning and were less often referred by general practitioners compared with involuntary patients who did not want admission. In a multivariate analysis, predictors for involuntary hospitalization and wanting admission were, not being transported by police, less aggression and less use of drugs. Conclusions: Almost a third of the involuntary admitted patients stated that they actually wanted to be hospitalized. It thus seems to be important to thoroughly address patients’ preferences, both before and after admission, regarding whether they wish to be hospitalized or not.

• Ruud, Torleif; Holgersen, Katrine Høyer; Hasselberg, Nina & Siqveland, Johan (2022). Accessibility and interventions of crisis resolution teams: a multicenter study of team practices and team differences in Norway. BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-03992-2. Full text in Research Archive Show summary

  Background Components of crisis resolution teams’ (CRTs) practices have been defined in recommendations and a fidelity scale, and surveys have reported how team leaders describe CRT practices. However, studies on CRTs have not measured and reported details of the crisis intervention provided to individual service users. The present study aimed to measure how various components of CRT practice were provided to individual service users and differences in practice between CRTs. Methods The study was exploratory and part of a prospective multicenter pre-post project on outcome of CRT treatment in Norway. Accessibility and intervention components of 25 CRTs were measured for 959 service users at the first contact after referral and in 3,244 sessions with service users. The data on CRT practice components were analyzed with descriptive statistics and factor analyses, and differences between teams were analyzed using ANOVA and calculating the proportion (intraclass correlation coefficient) of total variance that was due to differences between teams. Results One-third of the service users had their first session with the CRT the day of referral and another third the following day. Treatment intensity was mean 1.8 sessions the first week, gradually decreasing over subsequent weeks. Three of ten sessions were conducted in the service user’s home and six of ten in the team’s location. Eight of ten sessions took place during office hours and two of ten in the evening. The CRT provided assessment and psychological interventions to all service users. Family involvement, practical support, and medication were provided to two of ten service users. Between CRTs, significant differences were identified for a substantial proportion of practice components and especially for several aspects of accessibility. Cluster analysis identified two clusters of CRTs with significant differences in accessibility but no significant differences in the use of intervention components. Conclusions Measurements of accessibility and interventions provided to individual service users gave a detailed description of CRT practices and differences between teams. Such measurements may be helpful as feedback on clinical practice, for studying and comparing crisis resolution team practices, and in future studies on the association between different outcomes and potential critical elements of crisis interventions.

• Hasselberg, Nina; Klevan, Trude Gøril; Weimand, Bente; Uverud, Gunn-Marit; Holgersen, Katrine Høyer & Siqveland, Johan [Show all 7 contributors for this article] (2022). Similarities and differences between service users’ and carers’ experiences of crisis resolution teams in Norway: a survey. BMC Psychiatry. 22(1), p. 1–11. doi: 10.1186/s12888-022-03928-w. Full text in Research Archive Show summary

  Background Crisis resolution team (CRT) care in adult mental health services is intended to provide accessible and flexible short-term, intensive crisis intervention to service users experiencing a mental health crisis and involve their carers (next of kin). Research on users’ and especially carers’ experiences with CRT care is scarce and is mostly qualitative in nature. Methods Altogether, 111 service users and 86 carers from 28 Norwegian CRTs were interviewed with The Service User and Carer Structured Interviews of the CORE Crisis Resolution Team Fidelity Scale Version 2. Their experiences with different aspects of CRT care were reported with descriptive statistics, and differences between service users’ and carers’ experiences were analyzed with the Mann-Whitney U Test. Results The service users and carers reported that the CRT care mostly reflected their needs and what they wanted. The experiences of service users and carers were mostly similar, except for significant differences in received information and how the termination of CRT care appeared. Both groups experienced the organization of the CRT care as accessible, with continuity, reliability, and flexibility, but without a high intensity of care. Both groups found the content of the CRT care supportive, sensitive, with a choice of treatment type and a range of interventions beyond medication, but a lack of written treatment plans and discharge plans. Carers were rarely involved in discharge meetings. Regarding the role of CRTs within the care system, both groups agreed upon the lack of facilitation of early discharge from inpatient wards and lack of home treatment, but both groups confirmed some collaboration with other mental health services. Conclusion Service users and carers found that the CRTs were accessible, reliable, flexible, supportive, sensitive, and provided a range of interventions beyond medication. Limitations were lack of a high intensity of care, limited written treatment and discharge plans, limited provision of home treatment, and lack of gatekeeping of acute beds. Both groups experienced the CRT care as mostly similar, but with significant differences regarding involvement in care planning and discharge preparation.

• Hartveit, Miriam; Hovlid, Einar; Øvretveit, John; Assmus, Jörg; Bond, Gary & Joa, Inge [Show all 11 contributors for this article] (2022). Can systematic implementation support improve programme fidelity by improving care providers’ perceptions of implementation factors? A cluster randomized trial. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08168-y. Full text in Research Archive Show summary

  Background: Investigations of implementation factors (e.g., collegial support and sense of coherence) are recommended to better understand and address inadequate implementation outcomes. Little is known about the relationship between implementation factors and outcomes, especially in later phases of an implementation effort. The aims of this study were to assess the association between implementation success (measured by programme fidelity) and care providers' perceptions of implementation factors during an implementation process and to investigate whether these perceptions are affected by systematic implementation support. Methods: Using a cluster-randomized design, mental health clinics were drawn to receive implementation support for one (intervention) and not for another (control) of four evidence-based practices. Programme fidelity and care providers' perceptions (Implementation Process Assessment Tool questionnaire) were scored for both intervention and control groups at baseline, 6-, 12- and 18-months. Associations and group differences were tested by means of descriptive statistics (mean, standard deviation and confidence interval) and linear mixed effect analysis. Results: Including 33 mental health centres or wards, we found care providers' perceptions of a set of implementation factors to be associated with fidelity but not at baseline. After 18 months of implementation effort, fidelity and care providers' perceptions were strongly correlated (B (95% CI) = .7 (.2, 1.1), p = .004). Care providers perceived implementation factors more positively when implementation support was provided than when it was not (t (140) = 2.22, p = .028). Conclusions: Implementation support can facilitate positive perceptions among care providers, which is associated with higher programme fidelity. To improve implementation success, we should pay more attention to how care providers constantly perceive implementation factors during all phases of the implementation effort. Further research is needed to investigate the validity of our findings in other settings and to improve our understanding of ongoing decision-making among care providers, i.e., the mechanisms of sustaining the high fidelity of recommended practices. Trial registration: ClinicalTrials.gov Identifier: NCT03271242 (registration date: 05.09.2017). Keywords: Implementation; Implementation outcomes; Implementation process; Mental health; Readiness. © 2022. The Author(s).

• Andersson, Helle Wessel; Lilleeng, Solfrid; Ruud, Torleif & Ose, Solveig Osborg (2022). Suicidal ideation in patients with mental illness and concurrent substance use: analyses of national census data in Norway. BMC Psychiatry. 22(1). doi: 10.1186/s12888-021-03663-8. Full text in Research Archive Show summary

  Background - Suicidal ideation may signal potential risk for future suicidal behaviors and death. We examined the prevalence of recent suicidal ideation in patients with mental illness and concurrent substance use and explored the clinical and sociodemographic factors associated with suicidal ideation in this patient subgroup, which represents a particular risk group for adverse psychiatric outcomes. Methods - We used national cross-sectional census data in Norway collected from 25,525 patients in specialized mental health services. The analytic sample comprised 3,842 patients with concurrent substance use, defined as having a co-morbid substance use disorder or who reported recent regular alcohol use/occasional illicit drug use. Data included suicidal ideation measured in relation to the current treatment episode, sociodemographic characteristics and ICD-10 diagnoses. Bivariate and multivariate analyses were used to examine differential characteristics between patients with and without suicidal ideation. Results - The prevalence of suicidal ideation was 25.8%. The suicidal ideation rates were particularly high for those with personality disorders, posttraumatic stress disorder, and depression, and for alcohol and sedatives compared with other substances. Patients with suicidal ideation were characterized by being younger, having single marital status, and having poorly perceived social relationships with family and friends. Conclusion - Suicidal ideation in patients with mental illness and concurrent substance use was associated with a number of distinct characteristics. These results might help contribute to an increased focus on a subgroup of individuals at particular risk for suicidality and support suicide prevention efforts in specialized mental health services.

• Fröding, Regina; Clausen, Hanne Kristin; Benth, Jurate Saltyte; Ruud, Torleif; Slade, Mike & Heiervang, Kristin Sverdvik (2022). Associations between personal recovery and service user-rated versus clinician-rated clinical recovery, a cross-sectional study. BMC Psychiatry. 22. doi: 10.1186/s12888-022-03691-y. Full text in Research Archive Show summary

  Background This study examined the relationship between service user-rated personal recovery and clinician-rated and service user-rated clinical recovery. The relationships between different subdomains of clinical recovery and personal recovery were also assessed. Methods In total, 318 mental health service users with a psychosis diagnosis and their clinicians from 39 sites across Norway completed standardized questionnaires regarding personal recovery, clinical symptoms and psychosocial functioning. Regression models were used to investigate the relationship between personal and clinical recovery. Results Overall, clinical recovery was positively associated with personal recovery, when rated both by service users and by clinicians. Personal recovery was associated with lower levels of depression, self-harm and problems with relationships when rated by the service users. Among the subdomains rated by the clinicians, personal recovery was associated with fewer problems with relationships and higher aggressiveness. Conclusions These findings suggest that affective symptoms are associated with personal recovery, indicating the need for greater focus on depression treatment among people with psychosis. Improving social connections is of importance for personal recovery, and might be an area where clinicians and service users can meet and find agreement on important treatment goals.

• Linde, Janniche; Schmid, Marit Therese; Ruud, Torleif; Fröding, Regina & Biringer, Eva Aaker (2022). Social Factors and Recovery: A Longitudinal Study of Patients with Psychosis in Mental Health Services. Community mental health journal. ISSN 0010-3853. 59(2). doi: 10.1007/s10597-022-01007-8. Full text in Research Archive Show summary

  To study the prospective associations between social factors and recovery in patients with psychotic disorders in mental health specialist services. In this prospective observational cohort study, analyzes were based on baseline- and follow-up data after 18 months from 108 patients with psychosis. Personal recovery was assessed by the Questionnaire about the Process of Recovery (QPR). Linear regression models were used to test the prospective associations between social predictor variables and QPR. An association was found between experienced quality of interpersonal relationships at baseline and change in QPR score over the next 18 months. Stratified analyzes showed that the effect of experienced quality of interpersonal relationships on recovery was due to an association among persons living with others. Patients’ experience of quality of interpersonal relationships are prospectively associated with recovery. In conclusion, findings indicate that interpersonal relationships and social interaction are central drivers of recovery in patients with psychotic disorders.

• Dahli, Mina Piiksi; Haavet, Ole Rikard; Ruud, Torleif & Brekke, Mette (2022). GPs’ identification of patients with mental distress: a coupled questionnaire and cohort study from norwegian urban general practice. BMC Primary Care. 23(1). doi: 10.1186/s12875-022-01865-x. Full text in Research Archive Show summary

  Background Mental health problems are one of the leading causes of disease burden worldwide, and are mainly diagnosed and treated in general practice. It is unclear however, how general practitioners (GPs) identify mental health problems in their patients. The aim of this study was to explore how patients’ self-reported levels of mental distress correspond with psychological diagnoses made by their GPs, and associations with sex, age, number of consultations, and somatic symptom diagnoses. Methods A questionnaire study coupled with retrospective and prospective cohort data from 553 patients aged 16–65 years in six GP offices in Oslo, Norway during 21 months in 2014–2016. Results We found that 73.3% of patients with self-reported high levels of mental distress versus only 13.3% of the patients with low levels of mental distress had received a psychological diagnosis (p < 0.01). We found an increase in number of consultations for the group with high levels of mental distress regardless of having received a psychological diagnosis (p < 0.01). There was also an increase in number of somatic symptoms (p = 0.04) and higher number of females (0.04) in this group. 35% of patients had received one or more psychological diagnosis by their GP. Mean CORE-10 score, being female and a high number of consultations was associated with having received a psychological diagnosis. In the adjusted analyses high CORE-10 score and a high number of consultations still predicted a psychological diagnosis. Conclusions We found a clear association between self-reported mental distress and having received a psychological diagnosis amongst the participants, and the probability for being identified increased with increasing levels of mental distress, and increasing number of visits to their doctor. This suggests that GPs can identify patients with high levels of mental distress in general practice in an adequate way, even though this can sometimes be a complex issue. Trial registration Trial registration The main study was retrospectively registered in ClinicalTrials.gov on August 10 2019 with identification number NCT03624829.

• Haugom, Espen Woldsengen; Stensrud, Bjørn; Beston, Gro; Ruud, Torleif & Landheim, Anne Signe (2022). Experiences of shared decision making among patients with psychotic disorders in Norway: a qualitative study. BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-03849-8. Full text in Research Archive Show summary

  Background: Shared decision making (SDM) is a process where the patient and the health professional collaborate to make decisions based on both the patient’s preferences and the best available evidence. Patients with psychotic disorders are less involved in making decisions than they would like. More knowledge of these patients’ experiences of SDM may improve implementation. The study aim was to describe and explore experiences of SDM among patients with psychotic disorders in mental health care. Methods: Individual interviews were conducted with ten persons with a psychotic disorder. They were service users of two community mental health centres. The transcribed material was analysed using qualitative content analysis. Results: Four-ffths of the participants in this study found that they received insufcient information about their health situation and treatment options. All participants experienced that only one kind of treatment was often presented, which was usually medication. Although the study found that diferent degrees of involvement were practised, two thirds of the participants had little impact on choices to be made. This was despite the fact that they wanted to participate and felt capable of participating, even during periods of more severe illness. The participants described how important it was that SDM in psychosis was based on a trusting relationship, but stated that it took time to establish such a relationship. Conclusions: This study with ten participants indicates that patients with psychotic disorders experienced that they were not allowed to participate as much as they wanted to and believed they were capable of. Some patients were involved, but to a lesser degree than in SDM. More and better tailored information communicated within a trusting relationship is needed to provide psychotic patients with a better basis for active involvement in decisions about their health care. Keywords: Shared decision making, psychotic disorders, mental health services, qualitative research

• Husum, Tonje Lossius; Ruud, Torleif; Lickiewicz, Jakub & Siqveland, Johan (2022). Measurement Properties of the Staff Attitude to Coercion Scale: A Systematic Review. Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.744661. Full text in Research Archive Show summary

  Objective: The Staff Attitude to Coercion Scale (SACS) was developed to assess mental health care staff’s attitudes to the use of coercion in treatment. The staff’s attitudes to the use of coercion may also influence their willingness to engage in professional development projects aimed at reducing use of coercion. This study systematically reviews the existing evidence related to the measurement properties of the SACS in papers published since the publication of SACS in 2008. Methods: Seven databases were searched for studies published until October 2021 assessing the measurement properties of SACS or using SACS. All original studies reporting data relevant for the assessment of measurement properties of the SACS were eligible for inclusion. The methodological quality of the studies was assessed and rated using the COnsensus-based Standard for the selection of health Measurement INstruments (COSMIN). Results: Of the 81 identified publications, 13 studies with a total of 2,675 respondents met the inclusion criteria. Most studies reported data on structural validity and internal consistency, with high methodological quality, but there were almost no data on any other measurement properties. Conclusion: We found evidence for adequate structural validity and internal consistency of the SACS, while other important measurement properties were not addressed in any of the reviewed studies. Caution is needed when interpreting results of the SACS in terms of aspects such as reliability, criterion validity and measurement error. The relationship between staff attitudes to coercion and the actual use of coercion also remains unclear and needs to be further investigated.

• Stavnes, Kristin Anne; Ruud, Torleif; Benth, Jurate Saltyte; Hanssen-Bauer, Ketil; Weimand, Bente Margrethe & Solantaus, Tytti [Show all 13 contributors for this article] (2022). Norwegian health personnel’s compliance with new legislation on children of ill parents: an exploratory cross-sectional multicentre study. BMC Health Services Research. 22(1), p. 1–18. doi: 10.1186/s12913-022-08268-9. Full text in Research Archive Show summary

  Background In 2010 the Norwegian Parliament introduced amendments to the Health Personnel Act requiring all health personnel to inform and offer help to their patients’ children and families. We evaluated whether health personnel adhered to their obligations outlined in the Act and investigated whether family and health services characteristics were associated with the degree of compliance with the legislation. Our study was part of a larger Norwegian multi-site study conducted in five health trusts across Norway, assessing the situation for families living with parental illness. Method: A cross-sectional study using quantitative data obtained from 518 patients 246 children and 278 health personnel was performed. All informants completed a questionnaire, including an instrument corresponding to the obligations in the legislation. Descriptive analyses, factor analysis and logistic regression analysis were used. Results: The legislation was only partially implemented in the clinics of the health trusts. Compared to estimates prior to the introduction of the new legislation, the situation had improved somewhat, but much work remains to be done to fulfil the obligations decreed by law. The more time-consuming the obligations were, the less often they were met. The substance abuse and mental health services followed up on their obligations to a greater extent than did the physical health services. Conversely, children of physically ill parents were better informed by their families than were children of parents with mental health and substance abuse disorders. When asked the same questions, reports from health personnel were more positive compared to those of children and patients regarding the legislation’s fulfillment. Conclusion: Data suggest that there has been a change in the support offered to children of ill parents. Additional work is required, however, for the Health Personnel Act to function as fully intended.

• Hestmark, Lars; Heiervang, Kristin S.; Pedersen, Reidar; Hansson, Kristiane Myckland; Ruud, Torleif & Romøren, Maria (2021). Family involvement practices for persons with psychotic disorders in community mental health centres – a cross-sectional fidelity-based study. BMC Psychiatry. 21, p. 1–11. doi: 10.1186/s12888-021-03300-4. Full text in Research Archive Show summary

  Background Family involvement for persons with psychotic disorders is supported by scientific evidence, as well as legal and ethical considerations, and recommended in clinical practice guidelines. This article reports a cross-sectional measurement of the level of implementation of such guidelines in fifteen community mental health centre units in Norway, and presents a novel fidelity scale to measure basic family involvement and support. The aim was to investigate current family involvement practices comprehensively, as a basis for targeted quality improvement. Methods We employed three fidelity scales, with 12–14 items, to measure family involvement practices. Items were scored from 1 to 5, where 1 equals no implementation and 5 equals full implementation. Data was analysed using descriptive statistics, a non-parametric test, and calculation of interrater reliability for the scales. Results The mean score was 2.33 on the fidelity scale measuring basic family involvement and support. Among patients with psychotic disorders, only 4% had received family psychoeducation. On the family psychoeducation fidelity assessment scale, measuring practice and content, the mean score was 2.78. Among the eight units who offered family psychoeducation, it was 4.34. On the general organizational index scale, measuring the organisation and implementation of family psychoeducation, the mean score was 1.78. Among the units who offered family psychoeducation, it was 2.46. As a measure of interrater reliability, the intra-class correlation coefficient was 0.99 for the basic family involvement and support scale, 0.93 for the family psychoeducation fidelity assessment scale and 0.96 for the general organizational index scale. Conclusions The implementation level of the national guidelines on family involvement for persons with psychotic disorders was generally poor. The quality of family psychoeducation was high, but few patients had received this evidence-based treatment. Our novel fidelity scale shows promising psychometric properties and may prove a useful tool to improve the quality of health services. There is a need to increase the implementation of family involvement practices in Norway, to reach a larger percentage of patients and relatives. Trial registration ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.

• Lickiewicz, Jakub; Husum, Tonje Lossius; Ruud, Torleif; Siqveland, Johan; Musiał, Zofia & Makara-Studzińska, Marta (2021). Measuring Staff Attitudes to Coercion in Poland. Frontiers in Psychiatry. 12(12). doi: 10.3389/fpsyt.2021.745215. Full text in Research Archive Show summary

  Introduction: Coercion can be defined as the use of force to limit a person’s choices. In Poland, coercive measures may tend to be overused. However, there is limited information regarding the attitudes of nurses toward coercion in psychiatric settings and the factors influencing any decisions to use coercion. Aims: To validate the Staff Attitudes to Coercion Scale (SACS) for a group of psychiatric nurses and psychiatrists, to compare the said with the original Norwegian SACS version, and to compare nurses’ attitudes with those displayed by psychiatrists. A second aim was to understand the relationship between self-efficacy and attitudes to coercion. Method: We surveyed 351 psychiatric nurses and psychiatrists rating SACS and GSES (General Self Efficacy Scale). We validated the SACS factor structure using confirmatory principal component factor analysis, calculated the internal consistency of subscales, and analyzed the test-retest reliability and face validity of the subscales themselves. Further, we analyzed the differences in attitudes toward coercion between nurses and psychiatrists, as well as whether there was an association between GSES and the SACS subscales. We compared the means on the SACS items between three countries—Germany, Norway, and Poland. Results: The confirmatory factor analysis of the Polish version of SACS found the same factor structure with three factors as was displayed in the original Norwegian SACS, except that one item was loaded on another factor. Internal consistency was acceptable for the factors on coercion as security and the coercion as offending, and unacceptable for the factor on coercion as treatment. Test-retest reliability was excellent for all the three subscales. Face validity was high for the factor coercion as security, partly present for coercion as offending, and not present for coercion as treatment. The subscale Coercion as Treatment was rated significantly higher by nurses than by psychiatrists, but there was no difference for the two other subscales. There was no significant association between the General Self-Efficacy Scale and any of the SACS subscales. The biggest differences in attitudes toward forms of coercion was noted between Poland and Germany. Discussion: The three-factor structure of SACS was the best solution for the Polish nurses and psychiatrists. The attitudes toward coercion differed between the two groups, but a low correlation was computed for the SACS subscales and self-efficacy. There is a cultural diversity visible amongst the three countries examined. Reduction in the use of coercion is a priority worldwide. More knowledge about the process involved in using coercive measures may contribute to this. The use of coercive interventions may harm patients and threaten patients’ rights. Thus, education is needed for pre-service and in-service nurses alike.

• Maybery, Darryl; Jaffe, Irene Casey; Cuff, Rose; Duncan, Zoe; Grant, Anne & Kennelly, Melissa [Show all 10 contributors for this article] (2021). Mental health service engagement with family and carers: what practices are fundamental? BMC Health Services Research. 21(1), p. 1–11. doi: 10.1186/s12913-021-07104-w. Full text in Research Archive Show summary

  Background: Substantial and important benefits flow to all stakeholders, including the service user, when mental health services meaningfully engage with carers and family members. Government policies around the world clearly supports inclusiveness however health service engagement with family and carers remains sporadic, possibly because how best to engage is unclear. A synthesis of currently used surveys, relevant research and audit tools indicates seven core ways that families and carers might be engaged by health services. This study sought to confirm, from the perspective of family and carers, the importance of these seven health service engagement practices. Methods: In a mixed method online survey, 134 family members and carers were asked what they received and what they wanted from mental health services. Participants also quantified the importance of each of the seven core practices on a 0–100 point likert scale. Results: Almost 250 verbatim responses were deductively matched against the seven themes, with additional unaligned responses inductively categorised. The findings triangulate with multiple diverse literatures to confirm seven fundamental engagement practices that carers and family want from health services. Conceptually, the seven practices are represented by two broad overarching practice themes of (i) meeting the needs of the family member and (ii) addressing the needs of the service user. Conclusion: Policy, clinical practice, training and future research might encompass the seven core practices along with consideration of the intertwined relationship of family, carers and the service user suggested by the two broader concepts.

• Reupert, Andrea; Bee, Penny; Hosman, Clemens M. H.; Doesum, Karin van; Drost, Louisa M. & Falkov, Adrian [Show all 24 contributors for this article] (2021). Editorial Perspective: Prato Research Collaborative for change in parent and child mental health – principles and recommendations for working with children and parents living with parental mental illness. Journal of Child Psychology and Psychiatry. ISSN 0021-9630. doi: 10.1111/jcpp.13521. Full text in Research Archive Show summary

  Children whose parents have mental illnesses are among the most vulnerable in our communities. There is however, much that can be done to prevent or mitigate the impact of a parent’s illness on children. Notwithstanding the availability of several evidence-based interventions, efforts to support these children have been limited by a lack of adequate support structures. Major service reorientation is required to better meet the needs of these children and their families. This editorial provides recommendations for practice, organisational, and systems change.

• Haavet, Ole Rikard; Benth, Jurate Saltyte; Gjelstad, Svein; Hanssen-Bauer, Ketil; Dahli, Mina Piiksi & Kates, Nick [Show all 7 contributors for this article] (2021). Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office. BMJ Open. 11(12), p. 1–7. doi: 10.1136/bmjopen-2021-050036. Full text in Research Archive Show summary

  Background Young people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions. Aim To investigate whether shared care with mental health professionals in GP offices increases the detection of youth’s mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician. Design and setting This was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3–8 GP offices. One GP office was randomised to the intervention group and the other to the control group. Method We used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth. Results Over a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients’ regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm. Conclusion Shared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient’s regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group.

• Hasselberg, Nina Eide; Holgersen, Katrine Høyer; Uverud, Gunn-Marit; Siqveland, Johan; Lloyd-Evans, Brynmor & Johnson, Sonia [Show all 7 contributors for this article] (2021). Fidelity to an evidence-based model for crisis resolution teams: a cross-sectional multicentre study in Norway. BMC Psychiatry. 21. doi: 10.1186/s12888-021-03237-8. Full text in Research Archive Show summary

  Background: Crisis resolution teams (CRTs) are specialized multidisciplinary teams intended to provide assessment and short-term outpatient or home treatment as an alternative to hospital admission for people experiencing a mental health crisis. In Norway, CRTs have been established within mental health services throughout the country, but their fidelity to an evidence-based model for CRTs has been unknown. Methods: We assessed fidelity to the evidence-based CRT model for 28 CRTs, using the CORE Crisis Resolution Team Fidelity Scale Version 2, a tool developed and first applied in the UK to measure adherence to a model of optimal CRT practice. The assessments were completed by evaluation teams based on written information, interviews, and review of patient records during a one-day visit with each CRT. Results: The fidelity scale was applicable for assessing fidelity of Norwegian CRTs to the CRT model. On a scale 1 to 5, the mean fidelity score was low (2.75) and with a moderate variation of fidelity across the teams. The CRTs had highest scores on the content and delivery of care subscale, and lowest on the location and timing of care subscale. Scores were high on items measuring comprehensive assessment, psychological interventions, visit length, service users’ choice of location, and of type of support. However, scores were low on opening hours, gatekeeping acute psychiatric beds, facilitating early hospital discharge, intensity of contact, providing medication, and providing practical support. Conclusions: The CORE CRT Fidelity Scale was applicable and relevant to assessment of Norwegian CRTs and may be used to guide further development in clinical practice and research. Lower fidelity and differences in fidelity patterns compared to the UK teams may indicate that Norwegian teams are more focused on early interventions to a broader patient group and less on avoiding acute inpatient admissions for patients with severe mental illness.

• Nyttingnes, Olav; Benth, Jurate Saltyte & Ruud, Torleif (2021). Patient-controlled admission contracts: a longitudinal study of patient evaluations. BMC Health Services Research. 21, p. 1–13. doi: 10.1186/s12913-020-06033-4. Full text in Research Archive Show summary

  Background Mental health professionals usually decide patients’ access to inpatient care to ensure care based on need and potential benefit. The purpose of the current study is to investigate how patients evaluate admissions under a contract of Patient-Controlled Admissions (PCA), where the patient could initiate 5 day stays at a community mental health center at their own discretion. Methods Patients with a PCA contract in 2011 and 2012 were invited to participate in the study. Staff first recorded clinical baseline values for patients. Towards the end of each PCA stay, staff conducted a structured discharge interview of the admission with the patient. A structured follow-up interview evaluating the PCA arrangement 2 years after inclusion was also performed. We report frequencies from data on PCA requests, PCA admissions and the 2 year evaluation interview, and we used multiple regression models to explore predictors of perceived helpfulness and improvement from the PCA admissions. Results The included patients (n = 74) made 628 requests for PCAs during the 2 years after inclusion, and 507 PCAs took place. The five-day limit could not be upheld in 7.5% of PCAs. Patients rated PCAs as helping considerably (33.1%), a good deal (30.4%) or somewhat (21.1%), and reported feeling considerably (15.2%), a good deal (26.2%) or somewhat (36.3%) better during the admission. Significant predictors of helpfulness and feeling better were socializing more during the stay and reporting higher motivation to get away from a difficult situation or getting to the ward safety and calmness. A diagnosis of schizophrenia spectrum or bipolar disorder and more services from mental health specialist care also predicted feeling better during the PCA. In the two-year follow-up interview, 90% rated themselves as very or quite satisfied, and more than 90% would recommend PCAs to others. Conclusions The PCA arrangement was feasible and was frequently utilized by patients. Patients were satisfied with PCAs and the PCA arrangement. These short stays seemed particularly helpful for patients with a more severe diagnosis. Strong patient satisfaction gives reasons for testing and implementing increased patient influence on the mental health admission procedures in the form of PCAs.

• Dahli, Mina Piiksi; Benth, Jurate Saltyte; Haavet, Ole Rikard; Ruud, Torleif & Brekke, Mette (2021). Somatic symptoms and associations with common psychological diagnoses: a retrospective cohort study from Norwegian urban general practice. Family Practice. ISSN 0263-2136. 38(6), p. 766–772. doi: 10.1093/fampra/cmab038. Full text in Research Archive Show summary

  Abstract Background Patients with mental health problems often present with somatic symptoms when visiting their general practitioner (GP). Somatic presentations may challenge correct diagnosing of mental health disorders in general practice, where most of these disorders are treated. Objective Explore the associations between common psychological diagnoses and somatic symptom diagnoses in Norwegian urban general practice. Methods A retrospective cohort study including electronic medical data from 15 750 patients aged 16–65 years from 35 GPs in six GP offices in Oslo, Norway, during 12 months in 2014–2015. We explored prevalences and associations between anxiety-, depression-, and stress-related diagnoses, and somatic symptom diagnoses. Results Patients with anxiety-, depression- and stress-related diagnoses had a mean number of 2.9±3.6 somatic symptom diagnoses during the 12 months, compared to 1.9±2.5 for patients without any psychological diagnoses (P &amp;lt; 0.001). The mean number of somatic symptoms was significantly higher for the different psychological diagnoses viewed separately, for both sexes and different age groups. There was an increase in probability for anxiety, depression, or stress-related diagnoses with an increasing number of somatic symptom diagnoses during the 12 months. We found a significant increase in somatic symptom diagnoses from ICPC-2 chapters: General and unspecified, digestive, cardiovascular, musculoskeletal, neurological, urological, female genital disorders and social problems. Associated symptom patterns were different for each of the included psychological diagnoses. Conclusions This study shows that patients with anxiety, depression- and stress-related diagnoses present with increased and characteristic somatic symptoms compared to patients without these diagnoses in general practice.

• Hoel, Tone Larsen; Ruud, Torleif; Skjeldal, Eskil & Lauveng, Arnhild (2021). Helsepersonells egenerfaringer innen psykisk helse og rus – En pilotstudie. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 58(5), p. 390–397. Full text in Research Archive
• Benth, Jurate Saltyte; Fröding, Regina; Ruud, Torleif; Clausen, Hanne Kristin & Heiervang, Kristin S. (2021). The INSPIRE Support sub-scale: A critical view of the psychometric properties focusing on dimensionality. Current Psychology. ISSN 1046-1310. doi: 10.1007/s12144-021-01916-z. Full text in Research Archive Show summary

  The statistical methods previously used for assessing dimensionality of the INSPIRE Support sub-scale are often not valid, which may lead to inaccurate conclusions. The first aim of this paper was to present and discuss the methods for assessing the dimensionality of the scale. The second aim was to illustrate these methods using data from a Norwegian translation of the INSPIRE Support sub-scale. Exploratory factor analysis with several extraction and rotation methods was used to identify the dimensionality of the scale. Cronbach’s alpha and omega coefficient were employed to assess the internal consistency. Using the recognized statistical approach, there was no clear structure found in the Support sub-scale, indicating that the scale might be one-dimensional. While single items or sum score of the INSPIRE Support sub-scale might cover important aspects of the personal recovery concept, there is no evidence of the five CHIME dimensions of this scale as published earlier. A more thorough assessment is called for, and results from studies using the five dimensions should be interpreted with caution. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

• Fröding, Regina; Clausen, Hanne Kristin; Benth, Jurate Saltyte; Ruud, Torleif; Slade, Mike & Heiervang, Kristin Sverdvik (2021). The importance of personal recovery and perceived recovery support among service users with psychosis. Psychiatric Services. ISSN 1075-2730. 72(6), p. 661–668. doi: 10.1176/APPI.PS.202000223. Full text in Research Archive Show summary

  Objective: More knowledge is needed about whether personal recovery, as defined by the CHIME framework (connectedness, hope, identity, meaning and purpose, and empowerment), is considered important by service users with psychosis. This study examined the importance of personal recovery for a large, heterogeneous group of service users with psychosis and their perceived support from clinicians for personal recovery. Methods: This cross-sectional study used baseline data from 321 service users with psychosis from 39 clinical units across Norway. The INSPIRE Measure of Staff Support for Personal Recovery (based on CHIME) was used to examine personal recovery and perceived support provided for recovery. Twenty support-for-recovery items were each rated on importance (yes or no) and on the extent of support received (5-point scale). Bivariate and multiple linear regression models assessed variables associated with rated importance and support. Results: Most service users rated personal recovery items as important, regardless of their symptomatology and functioning. Previous experience with Illness Management and Recovery, knowledge about coping with stress and illness, and having a plan for early detection and prevention of relapse were significantly associated with higher perceived support. Higher self-reported depressive symptoms, lower score on the Global Assessment of Functioning symptom subscale, and male sex were significantly associated with less perceived support. Conclusions: Most service users with psychosis found personal recovery important, regardless of symptomatology and functioning, which has implications for clinical practice and provides empirical evidence that recovery-oriented treatments are relevant for most service users with psychosis in various mental health services. Keywords: PROM; Recovery; Schizophrenia; service user.

• Tveit, Ole Gunnar; Ruud, Torleif; Hanssen-Bauer, Ketil; Haavet, Ole Rikard & Hussain, Ajmal (2021). An explorative study of factors associated with treatment in specialized mental health care centers among GP patients in Norway. BMC Health Services Research. 21(1), p. 1–9. doi: 10.1186/s12913-021-06982-4. Full text in Research Archive Show summary

  Background: Effectiveness and efficiency are part of the quality of care for mental health problems, and treatment should thus be performed at the right level of care. Norwegian guidelines specify which patients should be given priority for treatment in specialized mental health care (SMHC) centers, but there is a lack of agreement on which patients should actually receive SMHC. In this study we wanted to examine what factors (patient and GP characteristics) were related to GP patients who received treatment in SMHC centers. Methods: Inthisretrospectivecohortstudy,welookedat12monthsofdatafromelectronichealthrecordsfromsix GP and SMHC centers of hospitals in the catchment area. We included all patients who had been treated at any of the GP centers during the 12-month period (N=18032). We fit a generalized linear mixed model to explore which factors were related to patients receiving treatment in SMHC centers. Further exploration was performed to study the effects of gender and contact frequency. Results: Wefoundthat4.6%ofallGPpatientsand18.4%oftheGPpatientswithamentalhealthproblemswere treated in SMHC centers. There were more women than men among the GP-patients (56% vs 44%) and in SMHC centers (55% vs 45%), women with mental health problems were more severely ill than men. However, after adjusting for other factors men were more likely to be treated in SMHC centers (OR: 1.44). Patients with frequent GP contact were more likely to be treated in SMHC centers. The GP characteristics age, gender and specialization did not relate to patients receiving treatment in SMHC centers. Conclusions: MenweremorelikelytobetreatedinSMHCcentersthanwomen,whichmayimplythattheyhave different thresholds for entering SMHC centers. GP characteristics were not related to receiving treatment in SMHC centers. More specific knowledge is needed to determine whether men and women currently receive treatment at the lowest possible level of care. Keywords: Psychiatricspecialistservices,Mentalhealthcare,Healthcareutilization,Norway

• Klevan, Trude Gøril; Karlsson, Bengt Eirik; Hasselberg, Nina Eide & Ruud, Torleif (2021). ‘No service is an island’: experiences of collaboration with crisis resolution teams in Norway. Journal of Interprofessional Care. ISSN 1356-1820. p. 1–7. doi: 10.1080/13561820.2021.1888900. Full text in Research Archive Show summary

  Crisis resolution teams (CRTs) are a community-based service targeting adults experiencing acute mental health crises. The rationale for the development of CRTs is both value and efficacy based, suggesting that CRTs should contribute to the humanizing of mental health services and replace some acute hospital-based services with services in the community. Despite the collaborative nature of CRT work, how professionals from health and social services experience collaboration with CRTs is scantly explored. In the current study, semi-structured focus group interviews with eight different groups of 44 clinicians collaborating with CRTs in Norway were conducted. Data were analyzed using thematic analysis and categorized into four themes: (1) ‘The accessible experts’, (2) ‘A broad and deep expertise’, (3) ‘Doing it together’ and (4) ‘Toward a new culture?’. The themes elaborate on issues related to the content and organization of CRT services, emphasizing the need for CRTs to be able to contribute their professional expertise in accessible, flexible and collaborative ways. A diversity in the knowledge base and in how services are organized may pose a challenge in interprofessional mental health crisis collaboration and mutual expectations. The study suggests that a shift toward a value-based and coherent mental health and social system could be a purposeful direction.

• Ruud, Torleif & Friis, Svein (2021). Community-based Mental Health Services in Norway. Consortium Psychiatricum. ISSN 2712-7672. 2(1), p. 47–54. doi: 10.17816/CP43. Full text in Research Archive
• Fröding, Regina; Clausen, Hanne Kristin; Benth, Jurate Saltyte; Ruud, Torleif; Slade, Mike & Heiervang, Kristin S. (2021). Relationship between satisfaction with mental health services, personal recovery and quality of life among service users with psychosis: a cross-sectional study. BMC Health Services Research. 21(1). doi: 10.1186/s12913-021-06409-0. Full text in Research Archive Show summary

  Background: Mental health policy internationally emphasizes patient centredness and personal recovery. This study investigated the relationship between satisfaction with mental health services among service users with psychosis in Norway, and personal recovery, perceived support for personal recovery, and quality of life. Methods: Cross-sectional data were collected from 292 service users diagnosed with psychosis from 39 clinical sites across Norway. Satisfaction with services was assessed using the Client Satisfaction Questionnaire-8. A linear mixed model was estimated to explore the relationship between satisfaction with services and preselected covariates, and to control for confounding factors. Results: A large majority of participants (89%) reported moderate-to-high levels of satisfaction. Satisfaction with services was positively associated with perceived support for personal recovery, but not with personal recovery or quality of life. In addition, service users under a Community Treatment Order (CTO) were significantly less satisfied than those who were not. Conclusions: Satisfaction levels among service users were higher compared with similar, international studies. Those who feel supported in their personal recovery were more satisfied with the care they receive, which support the need for implementation of recovery-oriented practices for service users with psychosis. However, satisfaction with services was not related to service user-rated quality of life or level of personal recovery; thus, more follow-up studies are needed. The lower satisfaction of service users placed under CTOs shows the importance of targeted interventions to improve satisfaction with services among this group. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

• Ruud, Torleif; Drake, Robert E.; Benth, Jurate Saltyte; Drivenes, Karin; Hartveit, Miriam & Heiervang, Kristin Sverdvik [Show all 16 contributors for this article] (2021). The Effect of Intensive Implementation Support on Fidelity for Four Evidence‑Based Psychosis Treatments: A Cluster Randomized Trial. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 48, p. 909–920. doi: 10.1007/s10488-021-01136-4. Full text in Research Archive Show summary

  Abstract Purpose: Service providers need effective strategies to implement evidence-based practices (EBPs) with high fidelity. This study aimed to evaluate an intensive implementation support strategy to increase fidelity to EBP standards in treatment of patients with psychosis. Methods: The study used a cluster randomized design with pairwise assignment of practices within each of 39 Norwegian mental health clinics. Each site chose two of four practices for implementation: physical health care, antipsychotic medication management, family psychoeducation, illness management and recovery. One practice was assigned to the experimental condition (toolkits, clinical training, implementation facilitation, data-based feedback) and the other to the control condition (manual only). The outcome measure was fidelity to the EBP, measured at baseline and after 6, 12, and 18 months, analyzed using linear mixed models and effect sizes. Results: The increase in fidelity scores (within a range 1-5) from baseline to 18 months was significantly greater for experimental sites than for control sites for the combined four practices, with mean difference in change of 0.86 with 95% CI (0.21; 1.50), p = 0.009). Effect sizes for increase in group difference of mean fidelity scores were 2.24 for illness management and recovery, 0.68 for physical health care, 0.71 for antipsychotic medication management, and 0.27 for family psychoeducation. Most improvements occurred during the first 12 months. Conclusions: Intensive implementation strategies (toolkits, clinical training, implementation facilitation, data-based feedback) over 12 months can facilitate the implementation of EBPs for psychosis treatment. The approach may be more effective for some practices than for others. Keywords: Evidence-based practice; Fidelity scale; Implementation support; Mental health services; Psychoses. © 2021. The Author(s).

• Frøkedal, Hilde; Stifoss-Hanssen, Hans; deMarinis, Valerie; Ruud, Torleif; Visser, Anja & Sørensen, Torgeir (2021). Participation in existential groups led by Norwegian healthcare chaplains: Relations to psychological distress, crisis of meaning and meaningfulness. The international journal for the psychology of religion. ISSN 1050-8619. p. 1–15. doi: 10.1080/10508619.2020.1844966. Full text in Research Archive Show summary

  Spirituality groups led by healthcare chaplains have been found to aid patients’ recovery processes in US psychiatric units. In Norway, existential groups (EGs) led by healthcare chaplains and co-led by healthcare staff members are offered at psychiatric units; these groups share commonalities with spirituality groups, group psychotherapy, existential therapy and clinical pastoral care, facilitating patients’ reflections regarding existential, spiritual and religious issues. The study aimed to examine associations between patients’ participation and topics discussed in the EGs and their experiences of psychological distress, crisis of meaning and meaningfulness. A cross-sectional design was applied among 157 patients attending EGs led by healthcare chaplains across Norway. Multivariate regression analyses assessed the strength of possible associations, adjusted for relevant demographical variables. Significant association was found between lengthier EG participation and lower levels of psychological distress, while discussion topics concerning religious and spiritual issues were significantly associated with the experience of meaningfulness.

• Birkeland, Bente; Weimand, Bente; Ruud, Torleif; Maybery, Darryl & Vederhus, John-Kåre (2021). Perceived family cohesion, social support, and quality of life in patients undergoing treatment for substance use disorders compared with patients with mental and physical disorders. Addiction science & clinical practice. ISSN 1940-0632. 16(1), p. 1–9. doi: 10.1186/s13722-021-00252-8. Full text in Research Archive Show summary

  Purpose: Support from family and other social network elements can be important in helping patients to cope with practical and emotional consequences of diseases. The aim of the study was to examine perception of family and social support and quality of life (QoL) in patients undergoing treatment for substance use disorders (SUDs). We compared them with patients in treatment for mental disorders (MDs) and physical disorders (PDs). Methods: We used data from a national multicenter study that recruited patients (N  =  518) from three treatment domains; SUD treatment units, MD treatment units, and PD treatment units (severe neurological conditions or cancer). Data on family cohesion, social support, and QoL were compared across patient groups. In addition, data on health variables was collected. We used a multiple linear regression procedure to examine how health and support variables were associated with QoL. Results: Family cohesion and social support in the SUD and MD groups were rated at similarly low levels, substantially lower than in the PD group. The SUD group exhibited a somewhat lower QoL than did the PD group, but their QoL was still in the near-to-normal range. In contrast, the MD group had markedly low QoL. When examining factors associated with QoL, we found that greater family cohesion and social support were positively associated with QoL. Mental distress was the strongest factor, and was negatively associated with QoL (beta − 0.15, 95% CI  =  − 0.17/− 0.14, p  <  0.001). Conclusion: Service providers need to be aware of the weaker networks and less regulatory family and/or social support available to patients with SUDs. Providers should focus consistently on the social networks of patients and include patients’ families in treatment processes.

• Ruud, Torleif; Haugom, Espen Woldsengen; Pincus, Harold Alan & Hynnekleiv, Torfinn (2021). Measuring Seclusion in Psychiatric Intensive Care: Development and Measurement Properties of the Clinical Seclusion Checklist. Frontiers in Psychiatry. 12. doi: 10.3389/fpsyt.2021.768500. Full text in Research Archive Show summary

  Background: Acute psychiatric units in general hospitals must ensure that acutely disturbed patients do not harm themselves or others, and simultaneously provide care and treatment and help patients regain control of their behavior. This led to the development of strategies for the seclusion of a patient in this state within a particular area separated from other patients in the ward. While versions of this practice have been used in different countries and settings, a systematic framework for describing the various parameters and types of seclusion interventions has not been available. The aims of the project were to develop and test a valid and reliable checklist for characterizing seclusion in inpatient psychiatric care. Methods: Development and testing of the checklist were accomplished in five stages. Staff in psychiatric units completed detailed descriptions of seclusion episodes. Elements of seclusion were identified by thematic analysis of this material, and consensus regarding these elements was achieved through a Delphi process comprising two rounds. Good content validity was ensured through the sample of seclusion episodes and the representative participants in the Delphi process. The first draft of the checklist was revised based on testing by clinicians assessing seclusion episodes. The revised checklist with six reasons for and 10 elements of seclusion was tested with different response scales, and acceptable interrater reliability was achieved. Results: The Clinical Seclusion Checklist is a brief and feasible tool measuring six reasons for seclusion, 10 elements of seclusion, and four contextual factors. It was developed through a transparent process and exhibited good content validity and acceptable interrater reliability. Conclusion: The checklist is a step toward achieving valid and clinically relevant measurements of seclusion. Its use in psychiatric units may contribute to quality assurance, more reliable statistics and comparisons across sites and periods, improved research on patients' experiences of seclusion and its effects, reduction of negative consequences of seclusion, and improvement of psychiatric intensive care. Keywords: checklist; clinical seclusion checklist; emergency psychiatry; measurement properties; measuring; psychiatric acute wards; psychiatric intensive care; seclusion. Copyright © 2021 Ruud, Haugom, Pincus and Hynnekleiv.

• Drivenes, Karin; Vederhus, John-Kåre; Haaland, Vegard Øksendal; Ruud, Torleif; Hauge, Yina Luk & Regevik, Hilde [Show all 8 contributors for this article] (2020). Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport. Medicine. ISSN 0025-7974. 99(1), p. 1–8. doi: 10.1097/MD.0000000000018635. Full text in Research Archive Show summary

  This cross sectional study examined patients’ perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics. A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5=strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records. Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86–89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders. The MedSupport inventory was suitable for assessing the patients’ perceived support from health care service regarding their medication. Awareness of differences in patients’ perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.

• Dahli, Mina Piiksi; Brekke, Mette; Ruud, Torleif & Haavet, Ole Rikard (2020). Prevalence and distribution of psychological diagnoses and related frequency of consultations in Norwegian urban general practice. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2020.1783477. Full text in Research Archive Show summary

  Objective: To investigate the prevalence and distribution of psychological diagnoses made by general practitioners (GPs) in urban general practice and the related frequency of consultations during 12 consecutive months in Norwegian general practice. Design: A cross-sectional study with data extracted from 16,845 electronic patient records in 35 urban GP practices Setting: Six GP group practices in Groruddalen, Norway. Subjects: All patients aged 16–65 with a registered contact with a GP during 12 months in 2015. Main outcome measures: Frequency and distribution of psychological diagnoses made by GPs, and the number of patients’ consultations. Results: GPs made a psychological diagnosis in 18.8% of the patients. The main diagnostic categories were depression symptoms or disorder, acute stress reaction, anxiety symptoms or disorder and sleep disorder, accounting for 67.1% of all psychological diagnoses given. The mean number of consultations for all patients was 4.09 (95% CI: 4.03, 4.14). The mean number of consultations for patients with a psychological diagnosis was 6.40 (95% CI: 6.22, 6.58) compared to 3.55 (95% CI 3.50, 3.51) (p<0.01) for patients without such a diagnosis. Seven percent of the diagnostic variation was due to differences among GPs. Conclusions: Psychological diagnoses are frequent in urban general practice, but they are covered using rather few diagnostic categories. Patients with psychological diagnoses had a significantly higher mean number of GP consultations regardless of age and sex. Implications: The knowledge of the burden of psychological health problems in general practice must be strengthened to define evidence-based approaches for detecting, diagnosing and treating mental disorders in the general practice population.

• Ruud, Torleif; Drivenes, Karin; Drake, Robert E.; Haaland, Vegard Øksendal; Landers, Matthew & Stensrud, Bjørn [Show all 9 contributors for this article] (2020). The Antipsychotic Medication Management Fidelity Scale: Psychometric properties. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-020-01018-1. Full text in Research Archive Show summary

  The paper describes the Antipsychotic Medication Management Fidelity Scale and its psychometric properties, including interrater reliability, frequency distribution, sensitivity to change and feasibility. Fidelity assessors conducted fdelity reviews four times over 18 months at eight sites receiving implementation support for evidence-based antipsychotic medication management. Data analyses shows good to fair interrater reliability, adequate sensitivity to change over time and good feasibility. At 18 months, item ratings varied from poor to full fdelity on most items. Use of the scale can assess fdelity to evidence-based guidelines for antipsychotic medication management and guide eforts to improve practice. Further research should improve and better calibrate some items, and improve the procedures for access to information. Trial registration: ClinicalTrials.gov Identifer: NCT03271242. Keywords Psychosis · Antipsychotic medication · Implementation · Evidence-based practice · Fidelity scale

• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin S.; Weimand, Bente; Ruud, Torleif & Norvoll, Reidun [Show all 11 contributors for this article] (2020). Implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP): protocol for a cluster randomised controlled trial. BMC Health Services Research. 20:934, p. 1–15. doi: 10.1186/s12913-020-05792-4. Full text in Research Archive Show summary

  Background: Family involvement for persons with psychotic disorders is under-implemented in mental health care, despite its firm scientific, economic, legal and moral basis. This appears to be the case in Norway, despite the presence of national guidelines providing both general recommendations on family involvement and support in the health- and care services, and specific guidance on family interventions for patients with psychotic disorders. The aim of this project is to improve mental health services and the psychosocial health of persons with psychotic disorders and their relatives, by implementing selected recommendations from the national guidelines in community mental health centres, and to evaluate this process. Methods: The trial is cluster randomised, where 14 outpatient clusters from community mental health centres undergo stratified randomisation with an allocation ratio of 1:1. The seven intervention clusters will receive implementation support for 18 months, whereas the control clusters will receive the same support after this implementation period. The intervention consists of: 1. A basic level of family involvement and support. 2. Family psychoeducation in single-family groups. 3. Training and guidance of health care personnel. 4. A family coordinator and 5. Other implementation measures. Fidelity to the intervention will be measured four times in the intervention arm and two times in the control arm, and the differences in fidelity changes between the arms constitute the primary outcomes. In each arm, we aim to include 161 patients with psychotic disorders and their closest relative to fill in questionnaires at inclusion, 6 months and 12 months, measuring psychosocial health and satisfaction with services. Clinicians will contribute clinical data about patients at inclusion and 12 months. Use of health and welfare services and work participation, for both patients and relatives, will be retrieved from national registries. We will also perform qualitative interviews with patients, relatives, health care personnel and leaders. Finally, we will conduct a cost-effectiveness analysis and a political economy analysis. Discussion: This project, with its multilevel and mixed methods approach, may contribute valuable knowledge to the fields of family involvement, mental health service research and implementation science.

• Clausen, Hanne Kristin; Ruud, Torleif; Odden, Sigrun; Benth, Jurate Saltyte; Heiervang, Kristin S. & Stuen, Hanne Kilen [Show all 7 contributors for this article] (2020). Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment—A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams. Frontiers in Psychiatry. 11. doi: 10.3389/fpsyt.2020.607071. Full text in Research Archive Show summary

  Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use. Keywords: activity; assertive community treatment; co-occurring substance use; functioning; housing; psychiatric symptom; quality of life; severe mental illness. Copyright © 2020 Clausen, Ruud, Odden, Benth, Heiervang, Stuen and Landheim.

• Andersson, Helle Wessel; Lilleeng, Solfrid; Ruud, Torleif & Ose, Solveig Osborg (2020). Substance use among patients in specialized mental health services in Norway: prevalence and patient characteristics based on a natinal census. Nordic Journal of Psychiatry. ISSN 0803-9488. 75(3), p. 1–11. doi: 10.1080/08039488.2020.1817553. Full text in Research Archive Show summary

  Purpose The aim of this study was to investigate the clinical and demographic variation in the prevalence of substance use among the general psychiatric population in Norway. Methods A national census in psychiatric institutions and outpatient clinics was conducted. Data were returned for 2358 inpatients (response rate, 65%) and 23,167 outpatients (response rate, 60%). Substance use was measured based on substance use disorder diagnosis or reported substance use in the last 4 weeks (alcohol 2–4 days a week or more frequently/illicit drug use). Regression analyses controlling for demographic and sociodemographic characteristics were carried out. Results Substance use was identified in 32.4% of inpatients and 13.9% of outpatients. The most frequently reported substances used were alcohol, sedatives and cannabis. Among inpatients, the prevalence of substance use was highest in patients with schizophrenia, personality disorders and anxiety disorders. Among outpatients, the prevalence was highest in patients with schizophrenia and other psychoses. Inpatients with anxiety disorders and outpatients with schizophrenia and other psychoses had a significantly higher risk of substance use than other patients. In both samples, the prevalence of substance use was higher among males, 24 to 29-year-olds and the most socially deprived. Conclusions This study provides further knowledge about patients at risk for co-morbid substance abuse and poor treatment outcomes. Clinicians may consider targeting patients with schizophrenia and other psychoses, young males and those who are socially deprived in efforts to prevent emerging substance abuse and improve outcomes.

• Rugkåsa, Jorun; Tveit, Ole Gunnar; Berteig, Julie; Hussain, Ajmal & Ruud, Torleif (2020). Collaborative care for mental health: a qualitative study of the experiences of patients and health professionals. BMC Health Services Research. 20(844), p. 1–10. doi: 10.1186/s12913-020-05691-8. Full text in Research Archive Show summary

  Background:Health policy in many countries directs treatment to the lowest effective care level and encouragescollaboration between primary and specialist mental health care. A number of models for collaborative care havebeen developed, and patient benefits are being reported. Less is known about what enables and preventsimplementation and sustainability of such models regarding the actions and attitudes of stakeholders on theground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care inOslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mentalhealth centre in each intervention GP practice. GPs could seek their input or advice when needed and referpatients to them for assessment (including assessment of the need for external services) or treatment.Methods:We conducted in-depth qualitative interviews with GPs (n= 7), CMHC specialists (n= 6) and patients (n=11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers andbarriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis.Results:Participants reported positive experiences of how the model improved accessibility. First,co-locationmade GPs andCMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning throughcomplementary skills. The threshold for patients’access to specialist care was lowered, treatment could commence early,and throughput increased. Treatment episodes were brief (usually 5–10 sessions) and this was too brief according to somepatients. Second,having experienced mental health specialists in the teamand on the front line enabled early assessment ofsymptoms and of the type of treatment and service that patients required and were entitled to, and who could be treatedat the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation ofcare. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at astructural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable.Conclusions:Participants identified a range of benefits of collaborative care for both patients and services. However, thefunding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainablecollaboration can be achieved without governments changing funding structures.

• Weimand, Bente; Birkeland, Bente; Ruud, Torleif & Høie, Magnhild (2020). “It’s like being stuck on an unsafe and unpredictable rollercoaster” : Experiencing substance use problems in a partner. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. 37(3), p. 227–242. doi: 10.1177/1455072520904652. Full text in Research Archive Show summary

  Living with a partner with substance abuse problems may induce strains in an individual’s everyday life, including poor health, disrupted family life, and social isolation; this may lead to dropping out of education or work, a lack of safety and support, and facing various dilemmas and stigma. Aim: The purpose of this study was to explore these partners’ everyday life experiences, including their parental roles. Method: A qualitative design comprising qualitative interviews with ten partners and ex-partners was performed, and a thematic analysis was used. Results: The findings demonstrated that sharing their lives, including parenthood, with a partner with substance use problems affected every aspect of the participants’ lives, and entailed being influenced by their partner’s ups and downs. The overall theme, “being stuck on an unsafe and unpredictable rollercoaster”, is explored through three themes: “dilemmas, stigma, and shame”, “lack of safety, security, and support,” and “searching for hope and meaning.” Conclusion: As a result of the negative impact of their circumstances on their everyday lives, these individuals need support to handle the challenges that they face, but often find it difficult to ask for help. Peer support groups seemed helpful in enabling them to find ways out of their situation.

• Haugom, Espen Woldsengen; Stensrud, Bjørn; Beston, Gro; Ruud, Torleif & Landheim, Anne (2020). Mental health professionals’ experiences with shared decision-making for patients with psychotic disorders: a qualitative study. BMC Health Services Research. 20(1). doi: 10.1186/s12913-020-05949-1. Full text in Research Archive Show summary

  Background: Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient's preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals' experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals' SDM experiences with patients with psychotic disorders. Methods: Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis. Results: Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them. Conclusion: Health professionals' understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM. Keywords: Mental health care; Mental health professionals; Psychotic disorders; Shared decision-making.

• Kallander, Ellen Katrine; Weimand, Bente; Hanssen-Bauer, Ketil; Roy, Betty Van & Ruud, Torleif (2020). Factors associated with quality of life for children affected by parental illness or substance abuse. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. doi: 10.1111/scs.12868. Full text in Research Archive Show summary

  Background: There have been inconsistent findings from studies examining factors associated with quality of life (QoL) for children affected by parental illness. Aim: The aim of this study was to explore factors associated with self-reported QoL in children affected by parental illness or parental substance abuse. Design: A cross-sectional multicentre study. Methods: The sample included 246 families with children 8–18 years recruited via ill parents who received treatment for severe physical illness, mental illness or substance abuse in specialised health services. We performed multiple linear regression analyses to examine factors associated with the children’s self-reported QoL. Main outcome measure: KIDSCREEN-27. Results: The children’s self-reported QoL was positively associated with the ill parent’s self-reported physical health, the children’s self-reported social skills, the degree to which other adults took over the ill parent’s responsibilities, provision of sibling care, provision of health care for the ill parent and positive outcome of caregiving. The children’s QoL was negatively associated with the children’s self-reported responsibilities due to parental illness, provision of emotional care for the ill parent, negative outcomes of caregiving and external locus of control. The model explained 63% of the variance (adjusted R2) in children’s total QoL. Study limitations: Sampling bias may have occurred during recruitment. Conclusions: The findings suggest factors of importance for the children’s QoL. Clinicians should assess whether an ill parent’s physical health may influence negatively on their ability to perform daily responsibilities at home and care for their children, and clinicians can use children’s self-reported QoL to identify children who are most negatively affected.

• Joa, Inge; Johannessen, Jan Olav; Heiervang, Kristin S.; Sviland, Åse Karin; Nordin, Håkan & Landers, Matthew [Show all 9 contributors for this article] (2020). The Family Psychoeducation Fidelity Scale: Psychometric Properties. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 47, p. 894–900. doi: 10.1007/s10488-020-01040-3. Full text in Research Archive Show summary

  This study examined psychometric properties and feasibility of the Family Psychoeducation (FPE) Fidelity Scale. Fidelity assessors conducted reviews using the FPE fidelity scale four times over 18 months at five sites in Norway. After completing fidelity reviews, assessors rated feasibility of the fidelity review process. The FPE fidelity scale showed excellent interrater reliability (.99), interrater item agreement (88%), and internal consistency (mean = .84 across four time points). By the 18-month follow-up, all five sites increased fidelity and three reached adequate fidelity. Fidelity assessors rated feasibility as excellent. The FPE fidelity scale has good psychometric properties and is feasible for evaluating the implementation of FPE programs. Trial registration ClinicalTrials.gov Identifier: NCT03271242.

• Heiervang, Kristin S.; Egeland, Karina M.; Landers, Matthew; Ruud, Torleif; Joa, Inge & Drake, Robert E. [Show all 7 contributors for this article] (2020). Psychometric Properties of the General Organizational Index (GOI): A Measure of Individualization and Quality Improvement to Complement Program Fidelity. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 47, p. 920–926. doi: 10.1007/s10488-020-01025-2. Full text in Research Archive Show summary

  To assess the implementation of effective practices, mental health programs need standardized measures. The General Organizational Index (GOI), although widely used for this purpose, has received minimal psychometric research. For this study, we assessed psychometric properties of the GOI scale administered four times over 18 months during the implementation of a new program in 11 sites. The GOI scale demonstrated high levels of interrater reliability (.97), agreement between assessors on item ratings (86% overall), internal consistency (.77–.80 at three time points), sensitivity to change, and feasibility. We conclude that the GOI scale has acceptable psychometric properties, and its use may enhance implementation and research on evidence-based mental health practices.

• Faugli, Anne; Kufås, Elin; Haukland, Magne; Kallander, Ellen Katrine; Ruud, Torleif & Weimand, Bente (2020). ‘I have cried a lot’: a qualitative study on children experiencing severe parental illness. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. doi: 10.1111/scs.12938. Full text in Research Archive Show summary

  Background: A considerable body of research has explored implications of severe parental illness on children. How- ever, less is known about what children and adolescents with a severely ill parent experience as the most challenging. Aims: To describe what children with a severely ill parent experience as their most difficult challenge. Methods: A qualitative descriptive design with a manifest content analysis was used on data from a cross-sectional, multicenter study on children of patients in five Norwe- gian Health trusts. Data consisted of written textual responds from 238 children (age 8–18) to one open- ended question in a self-report questionnaire. Results: The overall theme concerning the children’s most difficult challenge was named ‘the drama of life unfoldment’, reflecting the parental illness’ impact on themselves, their relationships with others, and their life circumstances. The subthemes consisted of: Children’s experiences of difficult thoughts and feelings; negatively impaired relationship with parents, friends and others; and challenging life events and obstacles in welfare. Conclusions: The most difficult challenge experienced by the children with a severely ill parent implies life unfold- ment challenges and include negative personal and rela- tional impact, challenging life events and obstacles in welfare.

• Nyttingnes, Olav & Ruud, Torleif (2020). When patients decide the admission - A four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts. BMC Health Services Research. 20(1). doi: 10.1186/s12913-020-05101-z. Full text in Research Archive Show summary

  Background Mental health professionals usually decide patients’ access to inpatient care to ensure the rational and fair distribution of care based on need and prognosis. The purpose of the current study is to investigate the effects of increasing patients’ influence on admission by enabling patients to initiate brief inpatient stays of up to five days at a community mental health center. Patients can initiate admission according to their own discretion, outside the existing referral and gatekeeping system. Methods Patient-controlled admission (PCA) contracts were offered to eligible patients for inpatient stays in four community mental health centers in one health trust in Norway. Data on included patients’ inpatient stays at any of the hospitals’ mental health or addiction wards were collected by hospital electronic journal data extraction specialists for the two years before PCA contracts were introduced and the first two years after PCA contracts were introduced for the included patients. Results The included patients (n = 57) had 406 PCAs in the two years following signing PCA contracts. When comparing the periods before and after the introduction of the contracts, the total number of admissions increased from 203 to 498 (p < .001), while the number of inpatient days decreased from 7172 to 3178 (p < .001). No significant change in involuntary care was observed. A comparison of box plots of inpatient day use in the eight half-year periods of the study indicates a gradual increase in median inpatient days up to the signing of a PCA contract for the sample, and an abrupt reduction to a stable median level of inpatient days after signing a contract. Conclusions The included patients’ use of inpatient days changed profoundly after signing PCA contracts, similar to what previous studies of PCAs have indicated. In spite of the marked reductions in inpatient days, the pre-post design makes it impossible to rule out that the reductions were caused by regression toward the mean. No study of PCAs has reported negative effects, indicating that giving patients control over very short admissions is a feasible and potentially positive scheme in mental health care wards.

• Ruud, Torleif; Drake, Robert & Bond, Gary R. (2020). Measuring fidelity to evidence-based practices: Psychometrics. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 47(6), p. 871–873. doi: 10.1007/s10488-020-01074-7. Full text in Research Archive Show summary

  Abstract This special section presents the psychometric properties of fidelity scales used in a national mental health services project in Norway to improve the quality of care of people with psychoses. Across Norway, 39 clinical units in six health trusts participated. The project provided education, implementation support and fidelity assessments. The papers in the section address the psychometrics of fidelity measurement for the specific evidence-based practices: illness management and recovery, family psychoeducation, physical healthcare and antipsychotic medication management. Another paper analyzes the psychometrics of a scale measuring individualization and quality improvement that may be used in conjunction with fidelity scales for specific evidence-based practices. The first paper in the section presents the development and field of fidelity scales, and the two final papers with comments add some additional perspectives and discuss fidelity scales in a wider context. The psychometrics of the five scales were good to excellent. Fidelity assessment is a necessary and effective strategy for quality improvement.

• Ruud, Torleif; Høifødt, Tordis Sørensen; Hendrick, Delia Cimpean; Drake, Robert E.; Høye, Anne & Landers, Matthew [Show all 8 contributors for this article] (2020). The Physical Health Care Fidelity Scale: Psychometric Properties. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 47, p. 901–910. doi: 10.1007/s10488-020-01019-0. Full text in Research Archive Show summary

  Mental health programs need an instrument to monitor adherence to evidence-based physical health care for people with serious mental illness. The paper describes the Physical Health Care Fidelity Scale and study interrater reliability, frequency distribution, sensitivity to change and feasibility. Four fidelity assessments were conducted over 18 months at 13 sites randomized to implementation support for evidence-based physical health care. We found good to excellent interrater reliability, adequate sensitivity for change, good feasibility and wide variability in fidelity across sites after 18 months of implementation. Programs were more successful in establishing Policies stating physical health care standards than in implementing these Policies. The Physical Health Care Fidelity Scale measures and guides implementation of evidence-based physical health care reliably.

• Lauveng, Arnhild & Ruud, Torleif (2020). Hvilken tilrette legging gjøres for at personer med alvorlige psykososiale funksjons nedsettelser skal kunne delta ved nasjonale valg? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 57(10), p. 740–749. Full text in Research Archive
• Hartveit, Miriam; Hovlid, Einar; Nordin, Håkan; Øvretveit, John; Bond, Gary R. & Biringer, Eva Aaker [Show all 9 contributors for this article] (2019). Measuring implementation: development of the implementation process assessment tool (IPAT). BMC Health Services Research. 19:721, p. 1–12. doi: 10.1186/s12913-019-4496-0. Full text in Research Archive Show summary

  Background Implementation science comprises a large set of theories suggesting interacting factors at different organisational levels. Development of literature syntheses and frameworks for implementation have contributed to comprehensive descriptions of implementation. However, corresponding instruments for measuring these comprehensive descriptions are currently lacking. The present study aimed to develop an instrument measuring care providers’ perceptions of an implementation effort, and to explore the instrument’s psychometric properties. Methods Based on existing implementation literature, a questionnaire was designed with items on individual and team factors and on stages of change in an implementation process. The instrument was tested in a Norwegian study on implementation of evidence based practices for psychosis. Item analysis, factor structure, and internal consistency at baseline were examined. Results The 27-item Implementation Process Assessment Tool (IPAT) revealed large variation between mean score of the items. The total scale scores were widely dispersed across respondents. Internal consistency for the total scale was high (Cronbach’s alpha: .962), and all but one item contributed positively to the construct. The results indicated four underlying constructs: individual stages for behavioural change, individual activities and perceived support, collective readiness and support, and individual perceptions of the intervention. Conclusions The IPAT appears to be a feasible instrument for investigating the implementation process from the perspective of those making the change. It can enable examination of the relative importance of factors thought to be essential for implementation outcomes. It may also provide ongoing feedback for leaders tailoring support for teams to improve implementation. However, further research is needed to detect the instrument’s properties later in the implementation process and in different contexts.

• Frøkedal, Hilde; Sørensen, Torgeir; Ruud, Torleif; deMarinis, Valerie & Stifoss-Hanssen, Hans (2019). Addressing the existential dimension in treatment settings: Mental health professionals’ and healthcare chaplains’ attitudes, practices, understanding and perceptions of value. Archive for the Psychology of Religion/ Archiv für Religionspsychologie. ISSN 0084-6724. 41(3), p. 253–276. doi: 10.1177/0084672419883345. Full text in Research Archive
• Bjerke, Espen; Gjelstad, Kari & Ruud, Torleif (2019). Færre tvangsinnleggelser i psykisk helsevern? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(4), p. 339–341. doi: 10.4045/tidsskr.18.0657. Full text in Research Archive
• Kann, Inger Cathrine; Dahli, Mina Piiksi & Ruud, Torleif (2019). Ny samhandlingsmodell for pasienter med psykiske lidelser: Påvirkes sykefravær eller arbeidsavklaringspenger? Arbeid og Velferd. ISSN 1504-8217. Full text in Research Archive Show summary

  We have investigated whether closer collaboration at general practitioner centres in the treatment of mental disorders has affected the number of days with sickness absence and work assessment allowance. The collaboration model consisted of a psychologist and a psychiatrist working part-time at the centre and in collaboration with services in the borough. The model was tested at one general practitioner centre in each of three boroughs in Groruddalen in Oslo, while three centres in the same boroughs constitute the control group. The purpose of the collaboration model is for patients to have a better overall health service, with earlier identification of mental health problems, faster access to health care, more effective dialogue between the health services and increased assistance in the primary health care without having to be referred to the specialist health services. Identification of mental health problems in more patients and earlier intervention can probably contribute to a greater proportion of sickness absence being linked to diagnoses of mental health problems, but more adequate treatment can probably also limit long-term sick leave and drop-out from working life. We find that fewer people are on sick leave in the intervention group, but still see an increase in the number of sick days of almost 4 per cent, due to increased duration of sick leave and reduced use of graded sick leave. We also find an 8 percent reduction in the number of days with work clarification money. Both the increase in the number of sick days and the reduction in days with work assessment allowance are among those with mental disorders, which suggests that the change is due to the intervention. Closer collaboration between the primary health care and mental health services may be able to improve the health service, with earlier identification and treatment of mental health problems. Although sickness absence is increased, it is conceivable that earlier and more targeted interventions will prevent mental health problems from developing into more serious and prolonged disorders and to prevent transition to work clarification or disability benefits.

• Odden, Sigrun; Landheim, Anne; Clausen, Hanne Kristin; Stuen, Hanne Kilen; Heiervang, Kristin Sverdvik & Ruud, Torleif (2019). Model fidelity and team members' experiences of assertive community treatment in Norway: A sequential mixed-methods study. International Journal of Mental Health Systems. 13(65), p. 1–12. doi: 10.1186/s13033-019-0321-8. Full text in Research Archive Show summary

  Abstract Background: Assertive community treatment (ACT) is an evidence-based treatment for people with severe mental illness, and this model is used widely throughout the world. Given the various adaptations in different contexts, we were interested in studying the implementation and adaptation of the ACT model in Norway. The first 12 Norwegian ACT teams were established between 2009 and 2011, and this study investigated the teams’ model fidelity and the team members’ experiences of working with ACT. Methods: To investigate implementation of the ACT model, fidelity assessments were performed 12 and 30 months after the teams started their work using the Tool for Measurement of Assertive Community Treatment (TMACT). Means and standard deviations were used to describe the ACT teams’ fidelity scores. Cohen’s effect size d was used to assess the changes in TMACT scores from the first to second assessment. Qualitative focus group interviews were conducted in the 12 teams after 30 months to investigate the team members’ experiences of working with the ACT model. Results: The fidelity assessments of the Norwegian teams showed high implementation of the structural and organizational parts of the ACT model. The newer parts of the model, the recovery and evidence-based practices, were less implemented. Four of the six subscales in TMACT improved from the first to the second assessment. The team members experienced the ACT model to be a good service model for the target population: people with severe mental illness, significant functional impairment, and continuous high service needs. Team members perceived some parts of the model difficult to implement and that it was challenging to find effective ways to collaborate with existing health and social services. Conclusion: The first 12 Norwegian ACT teams implemented the ACT model to a moderate degree. The ACT model could be implemented in Norway without extensive adaptations. Although the team members were satisfied with the ACT model, especially the results for their service users, inclusion of the ACT team to the existing service system was perceived as challenging. Keywords: Assertive community treatment, Model fidelity, Team members, Tool for Measurement of Assertive Community Treatment (TMACT), Implementation

• Haugom, Espen Woldsengen; Ruud, Torleif & Hynnekleiv, Torfinn (2019). Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals. BMC Health Services Research. 19(879). doi: 10.1186/s12913-019-4727-4. Full text in Research Archive Show summary

  Abstract BACKGROUND: Seclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion. METHODS: This study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis. RESULTS: The main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff's sincere desire to provide good treatment and the patients' behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice. CONCLUSION: Ethical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff. KEYWORDS: Coercion; Ethics; Health professionals/mental health staff; Mental health services; Open-area seclusion; Seclusion; Shielding

• Lau, Bjørn; Shiryaeva, Olga; Ruud, Torleif & Victor, Mattias Erik (2019). What Are They Returning To? Psychosocial Work Environment as a Predictor of Returning to Work Among Employees in Treatment for Common Mental Disorders: A prospective observational pre–post study. PLOS ONE. 14(4). doi: 10.1371/journal.pone.0215354. Full text in Research Archive Show summary

  Introduction Long-term sick leave and disabilities due to common mental disorders are challenging for society, employers, and individuals. Hence, we wanted to investigate whether psychosocial work environments experienced by employees undergoing treatment for such disorders was associated with return to work. Methods At the start of treatment, 164 patients responded to questionnaires concerning their psychosocial work environment (the Job Demand–Control–Support model and the Effort–Reward Imbalance model), symptoms (The Clinical Outcomes in Routine Evaluation Outcome Measure) and ability to work (Work Ability Index). In addition, the respondents reported whether they were working or on sick leave at the start and end of their courses of treatment. Their therapists provided information about diagnoses. Results Return to work was associated with control of decisions, support from colleagues, esteem, and job promotion opportunities as measured at the start of treatment. In multivariate analyses, control over decisions and job promotion opportunities continued to predict return to work when adjusted for symptoms, current work ability, and expected future work ability. Discussion The working conditions that predicted return to work are considered to facilitate work performance and to be sources of motivation, job satisfaction, and job commitment. Consequently, it is important to examine whether this patient group has a favorable working environment and consider changes in the workplace if the environment is not favorable.

• Ådnanes, Marian; Kalseth, Jorid; Ose, Solveig Osborg; Ruud, Torleif; Rugkåsa, Jorun & Puntis, Stephen Robert (2019). Quality of life and service satisfaction in outpatients with severe or non-severe mental illness diagnoses. Quality of Life Research. ISSN 0962-9343. 28(3), p. 713–724. doi: 10.1007/s11136-018-2039-5. Full text in Research Archive Show summary

  Purpose Our study investigated quality of life (QoL) in patients with severe or non-severe mental illness diagnoses (SMI and non-SMI) and the association between QoL and service satisfaction measured as patients’ perception of continuity of care (CoC), therapeutic relationship, and unmet service needs. Methods We conducted a national cross-sectional survey among 3836 mental health outpatients, of whom 1327 (34.6%)responded. We assessed QoL with the Manchester Short Assessment of Quality of Life (MANSA), CoC with the CONTINUUM, the therapeutic relationship with the Therapeutic Relationship in Community Mental Health Care (STAR-P) and developed a simple scale to measure unmet service needs. Results Outpatients with SMI (n = 155) reported significantly better QoL than those with non-SMI (n = 835) (p = 0.003). In both groups, QoL was positively associated with cohabitation (p = 0.007 for non-SMI and p = 0.022 for SMI), good contact with family and friends (p < 0.001 for both) and positive ratings of CoC (p < 0.001 for non-SMI and p = 0.008 for SMI). A positive association between QoL and therapeutic relationship (p = 0.001) and a negative association between QoL and unmet needs for treatment (p = 0.009) and activity (p = 0.005) was only found in the non-SMI group. Conclusion Our study highlights the important differences between those with SMI and those with non-SMI in their reported QoL and in the relationship between QoL and service satisfaction, with only non-SMI patients’ QoL influenced by the therapeutic relationship and unmet needs for treatment and activity. It also shows the importance of continuity of care and social factors for good QoL for both groups.

• Egeland, Karina M.; Heiervang, Kristin Sverdvik; Landers, Matthew; Ruud, Torleif; Drake, Robert E & Bond, Gary R. (2019). Psychometric Properties of a Fidelity Scale for Illness Management and Recovery. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-019-00992-5. Full text in Research Archive Show summary

  This study examined the psychometric properties and feasibility of the Illness Management and Recovery (IMR) Fidelity scale. Despite widespread use of the scale, the psychometric properties have received limited attention. Trained fidelity assessors conducted assessments four times over 18 months at 11 sites implementing IMR. The IMR Fidelity scale showed excellent interrater reliability (.99), interrater item agreement (94%), internal consistency (.91–.95 at three time points), and sensitivity to change. Frequency distributions generally showed that item ratings included the entire range. The IMR Fidelity scale has excellent psychometric properties and should be used to evaluate and guide the implementation of IMR.

• Egeland, Karina M.; Hauge, Mona-Iren; Ruud, Torleif; Ogden, Terje & Heiervang, Kristin Sverdvik (2019). Significance of Leaders for Sustained Use of Evidence-Based Practices: A Qualitative Focus-Group Study with Mental Health Practitioners. Community mental health journal. ISSN 0010-3853. 55. doi: 10.1007/s10597-019-00430-8. Full text in Research Archive Show summary

  Evidence-based practices that are implemented in mental health services are often challenging to sustain. In this focus-group study, 26 mental health practitioners with high fidelity scores were interviewed regarding their experiences with implementing the illness management and recovery, an evidence-based practice for people with severe mental disorders, in their services and how this could influence further use. Findings indicate that high fidelity is not equivalent to successful implementation. Rather, to sustain the practice in services, the practitioners emphasized the importance of their leaders being positive and engaged in the intervention, and hold clear goals and visions for the intervention in the clinic. In addition, the practitioners’ understanding of outcome monitoring as a resource for practice improvement must be improved to avoid random patient experiences becoming the decisive factor in determining further use.

• Skogøy, Bjørg Eva; Ogden, Terje; Weimand, Bente; Ruud, Torleif; Sørgaard, Knut W. & Maybery, Darryl (2019). Predictors of family focused practice: organisation, profession, or the role as child responsible personnel? BMC Health Services Research. 19:793, p. 1–13. doi: 10.1186/s12913-019-4553-8. Full text in Research Archive Show summary

  <p><i>Background - </i>Health professionals in Norway are required by law to help safeguard information and follow-up with children of parents with mental or physical illness, or who have substance abuse problems, to reduce their higher risk of psychosocial problems. Knowledge is lacking regarding whether organisation and/or worker-related factors can explain the differences in health professionals’ ability to support the families when patients are parents. <p><i>Methods - </i>Employing a translated, generic version of the Family Focused Mental Health Practice Questionnaire (FFPQ), this cross-sectional study examines family focused practice (FFP) differences in relation to health professionals’ background and role (<i>N</i> = 280) along with exploring predictors of parent, child, and family support. <p><i>Results - </i>While most health professions had begun to have conversations with parents on children’s needs, under one-third have had conversations with children. There were significant differences between nurses, social workers, psychologists, physicians, and others on seven of the FFP subscales, with physicians scoring lowest on five subscales and psychologists providing the least family support. Controlling for confounders, there were significant differences between child responsible personnel (CRP) and other clinicians (C), with CRP scoring significantly higher on knowledge and skills, confidence, and referrals. Predictors of FFP varied between less complex practices (talking with parents) and more complex practices (family support and referrals). <p><i>Conclusion - </i>The type of profession was a key predictor of delivering family support, suggesting that social workers have more undergraduate training to support families, followed by nurses; alternately, the results could suggest that that social workers and nurses have been more willing or able than physicians and psychologists to follow the new legal requirements. The findings highlight the importance of multidisciplinary teams and of tailoring training strategies to health professionals’ needs in order to strengthen their ability to better support children and families when a parent is ill.

View all works in NVA

• Ruud, Torleif (2025). Measuring subjective quality of life among users of mental health services in Norway. Social Work & Social Sciences Review. ISSN 0953-5225. 25(3). doi: 10.1921/swssr20252473. Full text in Research Archive
• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin Sverdvik; Hansson, Kristiane Myckland; Ruud, Torleif & Benth, Jurate Saltyte [Show all 9 contributors for this article] (2023). Correction to: Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial (Administration and Policy in Mental Health and Mental Health Services Research, (2023), 50, 3, (520-533), 10.1007/s10488-023-01255-0). Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-023-01291-w. Full text in Research Archive
• Skaare-Fatland, Klara; Hermann, Monica; Assmus, Jörg; Hartveit, Miriam; Ruud, Torleif & Drake, Robert [Show all 8 contributors for this article] (2023). Holdninger til legemidler hos pasienter med psykose. Full text in Research Archive
• Ruud, Torleif & Friis, Svein (2022). Continuity of care and therapeutic relationships as critical elements in acute psychiatric care. World Psychiatry. ISSN 1723-8617. 21(2), p. 241–242. doi: 10.1002/wps.20965. Full text in Research Archive
• Maybery, Darryl; Reupert, Andrea; Jaffe, Irene Casey; Cuff, Rose; Duncan, Zoe & Dunkley-Smith, Addy [Show all 11 contributors for this article] (2022). Getting the FACS: A Protocol for Developing a Survey Instrument to Measure Carer and Family Engagement with Mental Health Services. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(23). doi: 10.3390/ijerph192316279. Full text in Research Archive Show summary

  Government policies recommend, and all stakeholders benefit, when mental health services meaningfully engage with carers and family. However, health service engagement with carers is inadequate, and often non-existent with children whose parents are service users. There are seven fundamental ways that carers and families want to be integrated with and engaged by health services but current survey instruments do not capture these seven engagement practices. This protocol describes the development of two closely aligned Family and Carer Surveys (FACS) to measure engagement of service users in mental health services. The new measures are based on the seven engagement themes and a conceptual distinction between the carer and family, with particular focus on where the service user is a parent. The instruments will be developed in five stages; (1) item generation (2) Cognitive pretesting of survey (3) preliminary item content quantitative assessment (4) psychometric analysis of a large data collection and (5) selection of items for short form instruments. These steps will operationalise the seven fundamental ways that families and carers want to be engaged with mental health services, thereby providing valid and reliable measures for use in research and benchmarking of carer and family engagement.

• Linde, Janniche; Schmid, Marit Therese; Ruud, Torleif; Skar-Fröding, Regina & Biringer, Eva Aaker (2022). Correction: Social Factors and Recovery: A Longitudinal Study of Patients with Psychosis in Mental Health Services (Community Mental Health Journal, (2022), 10.1007/s10597-022-01007-8). Community mental health journal. ISSN 0010-3853. doi: 10.1007/s10597-022-01024-7. Full text in Research Archive
• Birkeland, Bente; Høie, Magnhild; Ruud, Torleif & Weimand, Bente (2019). Quality of life – why does it matter? Perceived quality of life in partners of patients undergoing treatment in physical health, mental health, or substance use disorder units: a crosssectional study. Full text in Research Archive Show summary

  To explore (1) differences in socio-demographic, social/familial, and health variables, and perceived quality of life (QoL) among partners of patients with physical illness, mental illness, or substance use disorders (SUD); and (2) identify factors associated with QoL. Why is this important? Studies comparing the QoL between partners to patients in different illness populations seems to be limited, especially when they share parenthood for children. Examining the partner's QoL, and factors associated with QoL is important to get a broadened picture of these families’ situation and needs in times of parental illness. What are the main discussion points you will raise in this presentation? • No QoL differences between groups but poorer scores on income/work for SUD-partners • 13 % had markedly low QoL indicating a very difficult situation • QoL covers domains in addition to strict health outcomes• Brief QoL tools might give valuable information about partners’ needs for support

• Dahli, Mina Piiksi; Brekke, Mette; Ruud, Torleif & Haavet, Ole Rikard (2019). Forekomst og distribusjon av psykologiske diagnoser og relatert hyppighet av konsultasjoner i norsk allmennpraksis. Full text in Research Archive
• Hustoft, Kjetil; Larsen, Tor Ketil & Ruud, Torleif (2022). Voluntary and involuntary hospitalizations in acute psychiatric wards in Norway. Universitetet i Stavanger. ISSN 9788284391250. Full text in Research Archive Show summary

  ENGLISH ABSTRACT Background and aim The use of coercion in mental health care services has been widely debated, and it is agreed that the level of coercive hospitalizations should be as low as possible. In 2004-2005, SINTEF Health was commissioned by the Norwegian Directorate of Health and Social Affairs to build up, establish and lead an Evaluation Network for Acute Psychiatry. SINTEF Health invited all local health trusts in Norway to participate. The purpose was for the local health trusts in Norway to come together and establish new knowledge about acute psychiatry - an area that so far had too little focus with regard to quality assurance and research in Norway. Thus, the Multi-Center Study for Acute Psychiatry (MAP) was established. This dissertation takes a closer look at the use of involuntary hospitalizations and the factors that influence this process. Study One: - Predictors of involuntary hospitalizations to acute psychiatry Rates of involuntary hospitalized (IH) patients and involuntary psychiatric treatment of people with mental illness reflect characteristics of national mental health care and laws or other legal frameworks. International studies on the rates of IH in psychiatric hospitals show great variability in results. It is, however, very difficult to compare figures due to differences in methodology of studies and legislation between countries. The aims of Study One were to examine to (i) the rates of patients admitted to 20 acute psychiatric ward units in Norway for IH, (ii) compare voluntary hospitalized (VH) with IH patients’ and (iii) describe the predictors of IH. Study Two: - Voluntary and involuntary acute psychiatric hospitalization in Norway: A 24h follow up study The Norwegian Mental Health Care Act states that patients who are involuntarily admitted to a hospital must be reassessed by a psychiatrist or a specialist in clinical psychology within 24 hours to assess whether the patient fulfils the legal criteria of the psychiatric status and symptoms. International research on the process of reassessment of IH in psychiatry is scarce, and an investigation of Norway's routine re-evaluation of IH patients may increase knowledge and understanding of this aspect of psychiatric treatment. The aims of Study Two were to (i) investigate the rate of conversion from IH to a VH status; and (ii) identify the predictors of conversion from IH to VH. Study Three: - Patients’ attitudes to psychiatric hospitalization: A national multicentre study in Norway. Being IH raises a number of issues: attitudes from family and society, stigma of being hospitalized against patients own will, and the conflict of autonomy versus need for treatment. Law/policymakers, governments and the public want a reduction in IH. The aims of Study Three were to (i) investigate to what degree do patients referred for VH and IH state that they want admission or not; and (ii) what are the predicting factors for IH patients who stated they wanted admission. Methods The Multi-centre study of Acute Psychiatry (MAP) included all cases of acute consecutive psychiatric admissions in 20 acute psychiatric units in Norway, representing about 75% of the Norwegian acute psychiatric units during 2005–2006. Data included an Admission registration form describing admission variables and the rating scales of Global Assessment of Functioning and Health of the Nation Outcome Scales. Of the full sample of 3.326 referred patients for admission, 3.051 patients provided data on wanting admission or not. We studied demographics and characteristics of the two groups (VH and IH). We then did a logistic regression analysis by using generalized linear mixed modelling based on data from 1.231 IH patients to calculate predictors of IH who wanted admission. Results Study One: Fifty-six percent of the sample were VH and 44% were IH. Regression analysis identified contact with police, referred by physicians who did not know the patient, contact with health services within the last 48 hours, not living in own apartment or house, high scores for aggression, level of hallucinations and delusions, and contact with an out-of office hours / emergency primary health care clinic within the last 48 hours and low GAF symptom score as predictors for IH. IH patients were older, more often male, non-Norwegian, unmarried and had a lower level of education. They were more likely to have a disability pension or received social benefits, and were more often admitted during evenings and nights, found to have more frequent substance abuse, less often responsible for children and were less frequently motivated for admission. IH patients had less contact with psychiatric services before admission. Most patients were referred because of a deterioration of their psychiatric illness. Study Two: Out of 1468, admissions who were IH (44%), 1148 (78.2%) remained on IH status, while 320 patients (21.8%) were converted to VH. The predictors of conversion from IH to VH (IH → VH) after re evaluation of a specialist included patients wanting admission, better scores on Global Assessment of Symptom scale (GAF), fewer hallucinations and delusions and higher alcohol intake. Study Three: 69.5% of the patients stated they wanted admission. As expected, 96.5% of the VH stated they wanted admission. However, nearly one-third (29.7%) of IH patients also expressed a need for hospitalization. In a multivariate analysis, we found that being IH and wanting admission were predicted by not being transported by police, having less aggression and using less drugs. Conclusions IH seems to be guided by the severity of psychiatric symptoms and characteristics of the referred patient such as male gender, substance abuse, contact with GP or not, aggressive behaviour, low level of social functioning and lack of motivation. There was a need for assistance by the police in a significant number of cases. This complexity challenges the organization of primary health care and psychiatric health services and highlights a need to consider better pathways to care. The 24-hour re – assessment period for patients referred for IH, as stipulated by the Norwegian Mental Health Care Act, appeared to give adequate opportunity to reduce unnecessary IH, while safeguarding the patient's right to VH. It is important to explore the attitude of a patient who has been referred to involuntary hospitalization. This can form the basis for a future dialogue about alternative ways of dealing with the patient's serious mental condition, and as far as possible preserve the patient's autonomy and co-determination, and if possible reduce unnecessary involuntary hospitalizations.Some patients who expressed the need for admission are still being admitted to acute psychiatric units under IH rather than VH. Thus, it is imperative that more effort should be made in the process of referral and admission by communication with patients in order to achieve a VH. By allowing more time for the referral and admission process, the referring physician may gain more knowledge of the patient such that an IH would not be necessary. It is not within the study to establish causality concerning wrongful involuntary admission, but it is important to focus on the patient’s wishes in such complicated hospitalization processes. It is conceivable that coercion is used too much in some places. However, at the same time patients may need to receive treatment in a psychiatric hospital when this is necessary despite not being in agreement with the referral physician. Coercion should only be used based on Mental Health Care Act criteria and when it is strictly necessary for the treatment.

• Ruud, Torleif; Birkeland, Bente; Faugli, Anne; Hagen, Kristine Amlund; Hilsen, Marit & Kallander, Ellen Katrine [Show all 13 contributors for this article] (2021). Barn som pårørende. Resultater fra oppfølgingsundersøkelsen. Helsedirektoratet . Full text in Research Archive
• Fjellstad, Ingrid Kyte & Ruud, Torleif (2020). Rapport om utvikling og utprøving av skjemaet «Pasienters erfaringer fra psykiatriske døgnavdelinger for eldre» (PEPDE). Akershus universitetssykehus. Full text in Research Archive Show summary

  Sammendrag Formålet har vært å utvikle et pålitelig spørreskjema/intervjuskjema om pasienterfaringer ved alderspsykiatrisk avdeling, slik at dette kan brukes i arbeid med kvalitetsforbedring og i forskning. Bakgrunn: Ledelsen og ansatte ved alderspsykiatrisk døgnavdeling, Akershus universitetssykehus HF (Ahus) ønsket informasjon om pasienters erfaringer med behandlingstilbudet. Vi gjorde en pilotundersøkelse med to eksisterende spørreskjema om pasienterfaringer i psykiatriske døgnavdelinger for voksne, men fant at disse ikke fungerte for målgruppen. Ved litteratursøk fant vi heller ikke noe skjema om pasienterfaringer ved alderspsykiatriske avdelinger, og vi besluttet derfor å utvikle et eget skjema for målgruppen. Skjemautvikling og datainnsamling: Vi utviklet et intervjuskjema/spørreskjema på bakgrunn av litteraturgjennomgang, erfaringene fra utprøvingen av de to skjemaene for voksne, diskusjoner i en referansegruppe, og kunnskap og egne erfaringer med utvikling av spørreskjema/intervjuskjema. Skjemaet dekket de temaene som vi fant ved litteraturgjennomgang av forhold som kunne ha betydning for alderspsykiatriske døgnpasienter. Utkastet til et eget skjema for alderspsykiatriske pasienter ble så utprøvd i et samarbeid mellom alderspsykiatriske avdelinger ved helseforetak. I alt 151 pasienter ble intervjuet om sine erfaringer ved bruk av skjemaet, og det ble også registrert hvordan pasientene og intervjuerne opplevde spørsmålene og skjemaet. Skjemaet som ble prøvd ut er med som vedlegg bakerst i rapporten. Analyser, vurderinger og revisjon av skjemaet: Kommentarene fra pasienter og intervjuere ble gjennomgått, og uegnede spørsmål ble ikke tatt med i videre analyser og vurderinger. Vi gjorde så psykometriske analyser av spørsmål med gradert svarskala for å identifisere hvilke tema (faktorer) disse dekket og undersøkte den interne konsistensen mellom spørsmål om samme tema. Vi vurderte også om noen av spørsmålene burde reformuleres for å gjøre dem lettere å forstå. Ved en samlet vurdering basert på de nevnte forhold utformet vi så et kortere og bedre skjema som kunne fungere som spørreskjema og intervjuskjema om pasienters erfaringer i alderspsykiatriske døgnavdelinger. Utprøving og vurdering av ferdig skjema: Det ferdige skjemaet har så vært brukt rutinemessig i flere år ved Alderspsykiatrisk avdeling ved Ahus for tilbakemeldinger fra pasienter og som ledd i videreutviklingen av avdelingen. Vi fikk tilgang til en anonymisert del av dette materialet og har gjort psykometriske analyser av hvordan det ferdige reviderte skjemaet og spørsmålene i dette fungerer. De 20 spørsmålene i det ferdige skjemaet er dokumentert å gi pålitelige målinger av pasientenes erfaringer av medbestemmelse, bedring, relasjoner og om de har mottatt informasjon om pasientrettigheter. Svært få ubesvarte spørsmål tyder på at spørsmål og svarskala er godt forståelige. Ferdig skjema med veiledning: Skjemaet Pasienters erfaringer fra psykiatriske døgnavdelinger for eldre (PEPDE) med en kort orientering om utviklingen og en veiledning om bruk er med som vedlegg i rapporten. Skjemaet med orienteringen og veiledningen er også tilgjengelig på http://www.helsebiblioteket.no En engelsk versjon (Patients Experiences from Psychiatric Departments for Elderly, PEPDE) vil bli publisert i en vitenskapelig artikkel om skjemaet og utviklingen av skjemaet. Skjemaet er gjort tilgjengelig med Creative Commons lisens (lenke nederst på skjemaet) og kan brukes fritt så lenge utvikleren krediteres, at skjemaet ikke distribueres i endret form, og at det ikke brukes kommersielt.

• Victor, Mattias Erik; Lau, Bjørn; Ruud, Torleif & Lerdal, Anners Vetle (2020). Patient characteristics and factors associated with post-treatment work participation in a Norwegian return to work programme for common mental disorders. Universitetet i Oslo. Full text in Research Archive
• Selbekk, Anne Schanche; Faugli, Anne; Kufås, Elin; Løvås, Maren & Ruud, Torleif (2019). Kunnskapsoppsummering om situasjon og hjelp til barn og partnere av personer med rusproblemer. Akershus universitetssykehus. Full text in Research Archive

View all works in NVA