"Something is clashing" - intentions to offer Medication-Free services within a traditional mental health ward

Lise S Beyene; Marit H Hem; Alain Topor; Mads S Kopperud; Elin B Strand

doi:10.3389/fpsyt.2026.1711274

"Something is clashing" - intentions to offer Medication-Free services within a traditional mental health ward

Front Psychiatry. 2026 Feb 20:17:1711274. doi: 10.3389/fpsyt.2026.1711274. eCollection 2026.

Authors

Lise S Beyene¹, Marit H Hem², Alain Topor³, Mads S Kopperud^{4

5}, Elin B Strand^{2

6}

Affiliations

¹ Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway.
² Department of Health Sciences, Institute of Nursing and Health, VID-Specialized University, Oslo, Norway.
³ Department of Psychosocial Health, Agder University, Kristiansand, Norway.
⁴ Department of Mental Health, Oslo University Hospital, Oslo, Norway.
⁵ Department of Psychiatry, Lovisenberg Hospital, Oslo, Norway.
⁶ Division of Medicine, Department of Digital Health Research, Oslo University Hospital, Oslo, Norway.

Abstract

Introduction: Medication-Free treatment in mental healthcare aims to avoid pressure and coercion related to medication use, focusing on psychosocial interventions such as psychotherapy and milieu therapy. This approach emphasizes patient participation and voluntarism, aligning with human rights and shared decision-making principles. Knowledge about the challenges faced by mental healthcare professionals when introducing Medication-Free treatment in traditional mental health wards remains limited. This study aimed to explore the experiences of mental health professionals working in a ward that also offers Medication-Free services in order to gain a deeper understanding of this practice.

Methods: A qualitative case study was conducted with two focus groups from a community mental health center ward in Eastern Norway. Data were analyzed using thematic analysis.

Results: The overall theme, Medication-Free services clash with a traditional medical system, was a common thread among the three themes: 1) Working within an inflexible structure: Mental health professionals experienced frustration due to rigid procedures that limited their ability to tailor treatments to individual patient needs. 2) The relationship between power and responsibility is not well balanced: Mental health professionals perceived a significant imbalance in power dynamics, with doctors and psychologists holding most of the authority. 3) Relational work with patients does not receive sufficient focus: Mental health professionals felt that the emphasis on relational work was inadequate, impacting the effectiveness of Medication-Free treatment.

Conclusion: Medication-Free services conflict with traditional medical systems due to fundamental differences in philosophy, structure, power dynamics and focus. Systemic changes are necessary to create a more flexible, empowering and relationship-focused milieu that supports both approaches effectively.

Keywords: Medication-Free treatment; implementation; mental healthcare; milieu therapy; patient participation; psychosocial interventions; qualitative case study; recovery.