• Kari Standal, Ole Andre Solbakken, Jorun Rugkåsa, Margrethe Seeger Halvorsen, Allan Abbass, Christopher Wirsching, Ingrid Engeseth Brakstad, and Kristin S Heiervang.
• District Psychiatric Center Nedre Romerike, Akershus University Hospital, Lørenskog, Norway.
• Patient Prefer Adher. 2024 Jan 1; 18: 315335315-335.

BackgroundNorwegian authorities have implemented treatment units devoted to medication-free mental health treatment nationwide to improve people's freedom of choice. This article examines how medication-free treatment differs from treatment as usual across central dimensions.MethodsThe design was mixed methods including questionnaire data on patients from a medication-free unit and two comparison units (n 59 + 124), as well as interviews with patients (n 5) and staff (n 8) in the medication-free unit.ResultsMedication-free treatment involved less reliance on medications and more extensive psychosocial treatment that involved a culture of openness, expression of feelings, and focus on individual responsibility and intensive work. The overall extent of patient influence for medication-free treatment compared with standard treatment was not substantially different to standard treatment but varied on different themes. Patients in medication-free treatment had greater freedom to reduce or not use medication. Medication-free treatment was experienced as more demanding. For patients, this could be connected to a stronger sense of purpose and was experienced as helpful but could also be experienced as a type of pressure and lack of understanding. Patients in medication-free treatment reported greater satisfaction with the treatment, which may be linked to a richer psychosocial treatment package that focuses on patient participation and freedom from pressure to use medication.ConclusionThe findings provide insights into how a medication-free treatment service might work and demonstrate its worth as a viable alternative for people who are not comfortable with the current medication focus of mental health care. Patients react differently to increased demands and clinicians should be reflexive of the dimensions of individualism-relationism in medication-free treatment services. This knowledge can be used to further develop and improve both medication-free treatment and standard treatment regarding shared decision-making.Trial RegistrationThis study was registered with ClinicalTrials.gov (Identifier NCT03499080) on 17 April 2018.© 2024 Standal et al.

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