In 2015, the Norwegian Health Minister issued a directive ordering regional health authorities to create a plan for providing mental healthcare without drugs. A new study published in Frontiers in Psychiatry examines the experiences of mental health professionals (MHP) working in a Norwegian facility that offers drug-free mental health services. This research, led by Lise S. Beyene from the university of Stavanger in Norway, finds that “medication-free services clash with a traditional medical system.”
The authors also identified three additional themes in MHP’s interviews: inflexible institutional structure, power and responsibility imbalance, and lack of focus on relational work. Some MHPs reported a strong focus on drugs and diagnosis and significant doubts about drug-free mental health treatment.
The authors conclude that the medication-focused institutional culture of of psychiatric hospitals undermines drug tapering and medication-free care. They write:
“A mismatch between the principles of Medication-Free care and existing organizational structures risks undermining treatment efforts. For such services to succeed, structural changes are needed to support interdisciplinary collaboration, clarify roles and prioritize relational work. Sustainable implementation depends not only on policy, but on everyday practices shaped by the lived realities of both patients and professionals.”
The medication-free initiative in Norway arose from a users-movement in that country that sought to have a choice regarding their use of psychiatric medications, which included a right to be treated in a hospital that provided “medication-free” treatment. The user groups, as they lobbied the Norwegian Ministry of Health for this right, argued that the drugs were of questionable efficacy, as only a small percentage of patients responded well to antipsychotics and other psychiatric drugs, and are associated with numerous harms.
The goal of the current study was to investigate MHP’s experience of working in a mental health facility that offers drug-free mental healthcare. The authors examined a single mental health facility in Eastern Norway. This psychosis treatment unit offers government mandated drug-free mental healthcare to service users admitted voluntarily. This facility also uses drug treatments for involuntary patients and those that do not opt for the drug-free approach. Those receiving drugs and drug-free treatment are given identical interventions. The only difference is that those opting for drug-free treatment are tapered off any drugs they are currently taking, which takes up to three months.
The authors decided to interview MHPs (nurses) as they were the staff most involved with the day-to-day implementation of the drug-free mental healthcare program. A department head recruited 10 MHPs with experience working in the drug-free ward to participate in the current study. Two authors conducted focus group interviews with the participants. Each focus group lasted about 60 minutes and included five participants. The authors then extracted overarching themes from the interview data.
The authors identified one overall theme within the focus group data, “medication-free services clash with a traditional medical system.” One participant said “I feel a bit of the problem is that you try to implement Medication-Free treatment into a system that is built on medication. Something is clashing.”
In addition to the clash between institutional structure and drug-free mental healthcare approaches, the authors identified three themes in the focus group data: working within an inflexible system, the relationship between power and responsibility is not well balanced, and relational work with patients does not receive sufficient focus. Within the first theme, “working within an inflexible system,” participants discussed having to adhere strictly to the ward’s treatment plan despite little to no strategies in place for the drug-free treatment option.
One participant said that they felt a lack of having a “joint project” with service users. “We set the goal, and then the patient just has to adapt to the goal in a way … It doesn’t feel like we have a joint project with the patient.” Others talked about the lack of communication and training for offering drug-free services. “It was planned that they should receive structured cognitive therapy and such, but it has not been fully initiated yet … I feel like we’ve got a machine, but nobody quite knows how to operate the machine.” Another participant expressed similar concerns: “I haven’t properly heard anything about it [Medication-Free treatment] as long as I’ve worked in this ward. I have only heard that the treatment is not quite set … That something is missing.”
MHP interviews also revealed that many staff members participating in drug-free mental health treatment believe diagnosis and medication to be central to recovery. One participant said “We lack the necessary tools if we’re not using medication.” Another expressed a critical view of tapering: “I don’t believe that if you have a severe diagnosis and have been on medication for so many years, you can taper off and stop taking medication.”
Within the second theme, “the relationship between power and responsibility is not well-balanced,” participants discussed having their perspectives ignored by doctors and psychologists, having no one on the ward with expertise in psychiatric drug tapering, and feeling powerless and unimportant. One participant expressed concerns about managing the drug-free approach while short-staffed:
“We may at times have to argue with the doctor and the psychologist. It is more than once I have been afraid that we might push a patient so much that we are anxious about the patient acting out, for example. Because we will be short of help, yes, that it will be too late, then, or that they could perhaps have avoided some emergency admissions, for example, if we had managed to help earlier.”
Within the third theme, “relational work with patients does not receive sufficient focus,” participants discussed how rapid tapering results in patients being transferred to an acute ward, time limitations making relational work more difficult, and a lack of dialogue around tapering. One participant talked about rapid tapering leading to aggression, which the institution does not know how to handle without the use of drugs:
“I’ve seen it in some cases where the goal is to reduce medication, and then you taper down, taper down, and suddenly the patient doesn’t do well or becomes very ill. Since we’re an open ward, we can’t handle aggression, so it often results in a transfer to acute care, which is a huge defeat for many. Then, it seems impossible to stop using medication.”
Another participant similarly recalled tapering patients too quickly:
“But I see with the doctors, when we have patients with substance use problems or heavy use of benzodiazepines, they taper down too quickly as well, without the patient having time to adjust and find … other coping strategies.”
This research had three key limitations. The focus groups were done with MHPs from a single facility in Eastern Norway, limiting generalizability to other populations. The small sample size, while typical of qualitative research, further limits generalizability. One of the authors was employed at the facility where the research took place. This could have biased some of the data.
While offering a drug-free option for mental healthcare is a step in the right direction, doing so without a strategy in place, within institutions that rely heavily on drugs, using staff with little training around drug-free mental health that are critical of the project, and having no one on the ward with expertise in drug tapering seems to significantly undermine this effort. The authors write:
“For Medication-Free services to be successfully integrated, systemic changes are needed, both in organizational structures and in the professional culture of mental health care, toward a context grounded in humanistic values and principles.”
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Beyene, L. S., Hem, M. H., Topor, A., Kopperud, M. S., & Strand, E. B. (2026). “something is clashing” – intentions to offer medication-free services within a traditional Mental Health Ward. Frontiers in Psychiatry, 17. (Link)