Subjective Experiences of Receiving Short-Term Care Through Brief Admission: A Study Based on Post-Discharge Written Patient Evaluations

Subjective Experiences of Receiving Short-Term Care Through Brief Admission: A Study Based on Post-Discharge Written Patient Evaluations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Subjective Experiences of Receiving Short-Term Care Through Brief Admission: A Study Based on Post-Discharge Written Patient Evaluations Sally Hultsjö, Reshad Hamid, Fredrik Granat, Filip Björkman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8679770/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 21 You are reading this latest preprint version Abstract Background Brief Admission (BA) is a complementary model of psychiatric inpatient care that allows individuals to initiate a short hospital stay of 1–3 days on their own initiative. Previous research has generally shown that BA is perceived as a valued intervention by patients, healthcare professionals, and significant others, and that it may promote patient participation while enabling the maintenance of everyday activities and social relationships. However, some individuals experience difficulties in assessing their need for BA and feel uncertainty about seeking BA, often related to prior negative experiences of psychiatric inpatient care. To ensure that care is both effective and person-centred, interventions need to be continuously evaluated in order to identify both effective components and areas for improvement that may enhance care quality. Aim The aim of this study was to explore patients’ subjective experiences of short inpatient stays within the context of BA. Method A qualitative inductive design was employed. Data consisted of 225 evaluation forms completed by patients who had been admitted through BA between 2018 and 2025. The responses were analysed using conventional content analysis to gain an in-depth understanding of the phenomenon and to identify patterns and relationships within the data. Results The findings indicate that BA provides support and facilitates recovery when users experience staff as validating and are offered opportunities for dialogue. The importance of a calm environment, structured routines, and access to either activities or rest was emphasised. The results further suggest that BA is most appreciated when used at an early stage and when a balance is achieved between the individual’s need for support and their level of personal responsibility. Conclusion BA constitutes a dynamic form of care that requires continuous balancing between support and autonomy, as well as between responsibility and relief, tailored to the individual’s needs and daily condition. Experiences Content analysis Non-suicidal self-injury Brief Admission Evaluation forms BACKGROUND Non-suicidal self-injury (NSSI) refers to the deliberate destruction of one’s own body tissue without suicidal intent and for purposes that are not socially sanctioned (1). The prevalence of NSSI may be as high as 20–30% in vulnerable populations, including adolescents and young adults, individuals in forensic and correctional settings, and psychiatric patients (2). Among individuals seeking psychiatric care, approximately 50% report a history of NSSI or suicide attempts (3). Understanding the underlying reasons for NSSI is essential for the development of more effective treatment interventions (2). Individuals who engage in NSSI often exhibit intense emotional reactivity alongside emotional inhibition and difficulties in understanding and regulating emotions using adaptive strategies (4). Although the psychological processes leading to self-injurious behaviour are complex and multifaceted, NSSI may serve multiple functions (4–6), including emotion regulation, communication of distress, and the modulation of interpersonal relationships (4–7). Females are more likely to engage in NSSI to alleviate negative emotions, enact self-punishment, or as a cry for help, whereas males more often associate NSSI with anger or the use of psychoactive substances (8). Thus, both emotional and social vulnerabilities shape the meaning and function of NSSI for the individual (2). Regardless of the form of self-injury, risk-prevention measures are a priority within psychiatric care. For individuals with NSSI, outpatient psychological treatment has demonstrated the greatest effectiveness (9). Such treatments primarily aim to modify maladaptive cognitive patterns and enhance emotion regulation to prevent destructive behaviours (10). Dialectical behaviour therapy, mentalization-based therapy, and schema therapy are among the interventions with the strongest evidence for reducing NSSI (11). Despite this evidence, access to psychological treatment remains insufficient, and individuals with NSSI continue to be high users of inpatient psychiatric care (12). Hospital admissions are often related to severe anxiety, chaotic life circumstances, and suicidal ideation (13–14), as well as severe self-injurious behaviour, intentional poisoning, or other forms of injury, with or without suicidal intent (15–17). The longstanding lack of evidence-based inpatient interventions has frequently resulted in prolonged hospitalizations and the use of coercive measures (15–17), which may undermine patient autonomy and contribute to poorer mental health outcomes (18). To reduce prolonged hospitalizations among individuals with NSSI, a short-term inpatient care model known as Brief Admission (BA) has been developed. BA complements outpatient care and may be used when individuals experience severe anxiety, self-injury urges, or suicidal ideation (19–24) In contrast to conventional psychiatric inpatient care, BA is initiated by the individual (25) and offers a brief stay of one to three days aimed at encouraging help-seeking before self-injury or suicidal behaviour occurs (26–30). During BA, individuals are provided with rest, regular meals, and sleep, which may reduce NSSI while promoting autonomy and self-care (28, 30–31). Research indicates predominantly positive experiences of BA among users, relatives, and healthcare professionals. Both patients and staff report that BA shifts the focus of care toward recovery and well-being rather than solely symptom reduction, as is often the case in traditional inpatient care (21, 28–29, 32). Healthcare professionals have described BA as a paradigm shift toward shared responsibility between staff and patients (22), enhancing patient autonomy and self-determination (22, 25). Nurses also report strengthened therapeutic relationships and more person-centred care (21–22, 25). BA has been found helpful in managing self-injury urges and reducing isolation (31–32), with decreases in self-injury frequency and anxiety and improvements in self-rated quality of life during admission (33–35). While total inpatient days may remain unchanged, BA is associated with shorter individual admissions (23, 34, 36). Overall, BA appears to be an acceptable care model that supports responsibility-taking while enabling individuals to maintain daily routines, work, and social relationships (28, 30, 35–38). BA has proven to be particularly effective for individuals with more severe functional impairments (38), especially when combined with other psychological interventions (32, 40). Relatives report increased reassurance from knowing that BA is available, which may reduce caregiver burden and anxiety (27, 41–42). This is echoed by BA users, who perceive that seeking BA alleviates strain on significant others (32). Including relatives in the BA process may further reduce burden and create respite for both parties (41–42). Despite its advantages, nurses have reported challenges in trusting patients’ capacity to assume responsibility for their own care (25), reflecting a shift from historically paternalistic care models. Recent studies also indicate that some individuals hesitate to seek BA due to negative prior experiences of psychiatric inpatient care or fear of being questioned or denied access (26, 29–31). Difficulties in assessing one’s own mental state may further delay help-seeking, sometimes resulting in symptom severity that precludes BA eligibility (31, 35). Additionally, exposure to other patients with similar difficulties during BA may be triggering for some individuals (29). For BA to effectively promote healthier behaviours, healthcare professionals must be aware of and actively address factors that hinder health-promoting processes (26). Individuals with NSSI experience preventive interventions in psychiatric care differently, depending on the function self-injury serves (43–44). To ensure both effectiveness and person-centredness, interventions such as BA should be individually tailored and continuously evaluated to identify strengths and areas for improvement in care quality (20, 38). Thus, the aim of this study was to explore individuals’ subjective experiences of short-term inpatient admissions through Brief Admission. METHODS Design A qualitative design with an inductive approach was employed, as this methodology allowing for an open exploration of subjective experiences and to identifying emerging patterns and relationships. (45–46). Data collection Since 2018, an ongoing research project in a region in southern Sweden has been conducted to evaluate Brief Admission (BA). At the initiation of the project, an evaluation form was developed by SH in collaboration with BA responsible staff, with the aim of assessing patients’ experiences of care during BA admissions (Appendix 1). In total, 141 patients with an active BA contract provided written informed consent to participate in the project. All consenting participants were offered the opportunity to complete an evaluation following each BA admission, focusing on their experiences and perceptions of the BA care period. The evaluations consisted of seven open-ended questions addressing experiences of the admission, engagement in activities, aspects perceived as most helpful during the stay, experiences of the BA room, perceptions of staff interactions, the impact of the admission on well-being, and suggestions for potential improvements. In addition, three items assessed perceived helpfulness of BA care, perceptions of staff treatment, and the extent to which BA-related goals were achieved during the admission. These items were rated on numerical scales ranging from 1 to 10, where 1 = not at all and 10 = completely agree. Data collection took place between June 2018 and December 2025 and comprises 225 evaluations completed by a total of 76 patients, of whom 68 were women, seven men, and one identified as non-binary. The mean age of participants was 32.5 years (range 20–55 years). More than four psychiatric diagnoses were reported by 55% of participants. The most common diagnoses were borderline personality disorder (66%), depression (42%), ADHD and/or autism spectrum disorder (42%), and post-traumatic stress disorder (38%). Regarding length of stay, the full three-day BA admission was utilized in 47% of admissions, two days in 29%, and one day in 25% of admissions. Each evaluation corresponded to a specific BA admission. Data Analysis The data were analysed using conventional qualitative content analysis (46). The analytic process was inductive, with findings derived from the data rather than from pre-existing categories or theoretical frameworks (45). All evaluations were initially read carefully and repeatedly to achieve an overall understanding of the material. Preliminary impressions and reflections were documented to support the subsequent analytic process. All written responses were then compiled into a single document and read as a whole to identify salient experiences within the data. Text segments considered relevant to the study aim were identified, condensed, and coded to capture their essential meaning. Codes were compared based on similarities and differences and organised into an initial coding scheme comprising eleven subcategories. Subcategories that described the same phenomenon from different perspectives were subsequently grouped into broader categories. The analysis was iterative and involved continuous movement between the original text, codes, and emerging categories. Throughout the process, ongoing analytical discussions were held regarding the content of the text, the meaning of the categories, and their interrelationships. This process resulted in two main categories with six associated subcategories. The final step of the analysis involved reviewing the categories in relation to the original data to ensure that no essential meanings were lost (46). Responses to the evaluation items in which participants rated their experiences were summarised as percentage data and are presented in the Results section under the relevant categories. To enhance the credibility of the findings, illustrative quotations from the evaluations are presented in connection with each subcategory (45). Ethical Considerations The study was approved by the Swedish Ethical Review Authority in Linköping (Ref. No. 2022–01530-02) and conducted in accordance with the ethical principles of the Declaration of Helsinki for research involving human participants (47). The handling of participants’ personal data complied with the General Data Protection Regulation (GDPR) and with established recommendations for ethical data management in human sciences research (48). All participants were aged 18 years or older and provided informed, voluntary consent after receiving both oral and written information about the study aims, the voluntary nature of participation, and their right to withdraw at any time without providing a reason. Participants also consented to the publication of anonymised data. The study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (49). A clinical trial registration number was not applicable. RESULTS The results are presented according to two main categories, each with three associated subcategories, to provide a detailed and nuanced understanding of the study material. Table 1 Overview of categories and subcategories, developed from the evaluations of Brief admission, according to the conventional content analysis (44). CATEGORY SUBCATEGORY THE CARING ENCOUNTER • Supportive Environments as a Basis for Seeking BA • The Importance of Staff Responsiveness and Understanding • The Importance of Safe and Accessible Conversations MANAGING ONE’S OWN PROCESS • The Role and Limitations of Activities During BA • Independence and Support in Medication Management • Planning and Utilizing the Brief Admission Stay THE CARING ENCOUNTER This category highlights how the interaction between patients and healthcare staff constitutes the core of the caring experience. Respectful treatment, access to supportive conversations, and the sense of being seen and heard within a safe environment emerged as central elements of BA. Together, these components foster a sense of security in which both human and environmental support interact synergistically. When any of these elements are lacking, BA users may experience uncertainty and reduced confidence in the care process. Supportive Environments as a Basis for Seeking BA The evaluations indicate that BA is primarily sought to obtain a change of environment, interrupt destructive thought patterns, and gain rest within a safe and supportive setting. Opportunities for structure and routine, as well as relief from everyday demands and burdens, were highlighted as particularly meaningful. This environment provides space for managing emotions in a more constructive manner, thereby reducing the risk of engaging in self-injurious behaviors. “Being in an environment where I can talk with staff and where there are fewer stimuli makes it easier for me to rest.” (P61) The evaluations highligth the significance of being met in a welcoming manner by staff who adhere to the contract and the content of the individual care plan. When staff lacked familiarity with the care mode, or when access to BA was limited due to bed availability, participants emphasized the importance of having alternative support options or courses of action available. Feeling that it is legitimate to seek BA, without experiencing guilt or the sense of taking someone else’s place, emerged as a crucial prerequisite for utilizing the service “It was helpful to know approximately when I could call back to ask about an available spot when it was occupied. It is beneficial to be allowed to schedule a time to call the same day it becomes available and attend once the previous person has left, so that one does not have to compete for the spot multiple times during the day and can ‘reserve’ it with the first confirmation.” (P47). Having the opportunity to securely store personal belongings in a designated BA room was perceived as a positive aspect of the stay. Furthermore, being cared for in a room separated from the regular wards, furnished in a homelike manner, was reported to reduce exposure to potentially overwhelming stimuli and create conditions conducive to rest and relaxation. When the designated BA room was occupied and care was provided in a regular ward room, participants reported a negative impact on their overall perception and experience of care. “I was placed in the wrong room. The BA room is nicer, with a bookshelf, desk, etc., and feels more homely, so this was lacking.” (P71). In addition to a supportive environment, the evaluations highlighted that a fundamental trust in the BA model is a prerequisite for seeking and engaging with the service. The Importance of Staff Responsiveness and Understanding Overall, participants reported high appreciation for staff interactions, with an average rating of 8 on a 1–10 numerical scale. "Difficult to rate. I experience very good treatment from everyone, except one who barely greeted me and seemed visibly annoyed the few times I asked for help. Otherwise good ♥." (64) Positive aspects of staff interactions included their demonstrated understanding of BA users’ situations and emotional states, as well as their willingness to listen when participants wished to share distressing thoughts. Conversely, when staff did not acknowledge or inquire about BA users’ well-being, participants reported feeling overlooked. The evaluations indicate that it is crucial for staff to be proactive and initiate contact, as many participants expressed difficulty in asking for support themselves, and not being noticed or validated was experienced as stressful. Some participants refrained from initiating contact due to concerns about taking time away from other patients or disturbing staff, which sometimes led to isolation in their room. "Check in on me more often during the day, as I tend to withdraw when I feel bad instead of asking for help." (P39). Experiences of supervision varied, some participants desired more regular check-ins, while others felt disturbed by excessive oversight. Further the evaluations highlight how BA-users felt anxious when there were to many new staff on the ward, and felt that it was easier to initiate contact and establish a trusting relationship with staff they were familiar with. "Comforting and helpful because I know them and they know me." (P11) Participants also expressed a desire for simpler ways to communicate with all staff when support or supervision was needed. The Importance of Safe and Accessible Conversations The evaluations indicate that conversations during the BA stay were generally appreciated. These interactions were described as distracting, positive, and helpful, allowing participants to verbalize their emotional states. Furthermore, conversations were experienced as strengthening, encouraging, and validating. Humility and approachability from staff were highlighted as important factors that contributed to a sense of safety during discussions. "I spoke with several staff members; they were kind and attentive." (70) Staff availability for conversations was emphasized with 84% of the evaluations reporting that discussions took place during the BA stay. Feeling safe with the staff member conducting the conversation was considered important and was often related to familiarity with the staff. "I experienced a conversation with a specific person as the best." (72) The results further show that it is important for conversations to be conducted privately, away from distractions, and that they should occur even if the ward environment is noisy or busy. Conversations conducted under time pressure were perceived as more stressful than helpful. Participants expressed a preference for staff to initiate conversations, with at least one discussion per day being desirable. "I find it difficult to approach staff if they are busy. I would appreciate if staff asked me sometimes. They suggested that I leave a note if I wanted a conversation." (71) Some participants reported that conversations were too brief or superficial and expressed a desire for deeper, more reflective discussions. "Aside from admission and discharge meetings, there were no deeper conversations. Everyone is very nice, but I missed something more in-depth." (P14) When conversations did not occur, it was not always due to staff being unavailable or lacking time; it could also result from the participant being occupied with other activities, away from the ward, or feeling too unwell to engage. "Okay, I wasn’t very receptive because I felt so bad." (P28) MANAGING ONE’S OWN PROCESS This category highlights BA users’ perceptions of their own responsibility in adhering to the individualized BA plan and goals. It encompasses participation in scheduled activities and the management of medications independently during the BA stay. Collectively, these components emphasize personal accountability as an integral part of the caring process. The Role and Limitations of Activities During BA The evaluations indicate that BA users engaged in various activities to support their well-being. Reported activities included resting under a weighted blanket, listening to music, going for walks, receiving tactile massage or NADA, and following the individualized crisis plan. Overall, planned activities were carried out in 68% of BA stays. Carrying out activities could be challenging, as it was primarily the BA user’s responsibility to request support for interventions such as tactile massage, conversations, or walks. In 21% of the evaluations it was stated that, planned activities were not completed. Reasons for non-completion included the BA user’s current mental or physical state, insufficient energy, or a lack of time or space to perform the planned activities. “I did not go for a walk; it was too difficult to get out, but otherwise I did what we had agreed on” (P14). Although initiating activities was largely the BA user’s responsibility, results indicate that staff availability and training could limit the implementation of activities listed in the individualized plan. When BA users requested alternative interventions, such as NADA or tactile massage, but these were not provided, they interpreted this as being burdensome and questioned whether they should have sought BA. “I received tactile massage on the first day (which was very beneficial), but on the second day there was no staff trained to provide it. That was unfortunate” (P28). Evaluations also reveal that spontaneous needs and wishes for activities arose during the BA stay. These included activities aimed at relaxation and rest, interaction with others, or simply leisure and enjoyment. “ I wished for more therapy. I know this is not a clinic, but something like that would have helped me. Even a small conversational contact could have encouraged me to open up… I would have liked group discussions or to play some games” (P70). Most participants reported feeling reassured by having planned activities outlined in the individualized plan, as this promoted and reinforced their sense of responsibility for managing their BA stay and well-being. However, some participants experienced difficulties remembering the activities they had documented in the plan, while others were uncertain about which activities could be carried out during the stay. “I do not remember all planned activities, but I used the items on my crisis list that always work positively” (P34). Independence and Support in Medication Management The findings indicate that managing one’s own medication during the BA stay was generally experienced as functioning well and contributed to a sense of independence and self-efficacy. “It felt good to have control over it myself.” (60) However, some participants reported challenges such as forgetting or losing track of time, which in turn led to missed medication. In these situations, staff provided reminders to support adherence. The evaluations further show that opportunities for independent medication management were not always available, particularly when participants were accommodated in rooms without lockable medication storage. “It felt good, but it was a bit difficult having to ask a nurse for my medication bag since I did not have the BA room but a regular room without a safe.” (P57). Most participants reported that medication management functioned well overall, although knowledge and experience regarding medication handling varied. Some participants did not manage their medications independently at home, which in some cases contributed to uncertainty among relatives. “It works well, but my husband is nervous about sending so much medication with me. I am not allowed to manage my medication at home due to a suicide attempt.” (P14). In such cases, responsibility for medication management was transferred to staff. Some participants also reported that it would have been relieving to be relieved of this responsibility during the BA stay. This was particularly relevant when participants experienced a deterioration in mental state or an increase in self-destructive or suicidal thoughts during the admission. “I was actually in a state where I needed to place the responsibility on someone else in order to get relief from all the suicidal and self-harm thoughts.” (P32) “It was fine, though difficult this time because I wanted to overdose on insulin, but it was handled well with the help of staff.” (P57) Planning and Utilizing the Brief Admission Stay The evaluations indicate that BA was perceived as helpful in 66% of admissions. Participants reported that their individual needs were largely met during the stay, and that overall well-being was influenced by the combined experience of available interventions, such as conversations with staff, structured activities, and opportunities for rest. “It is great that this form of help exists!” (P7) BA was appreciated as a form of care even when it did not lead to immediate or substantial improvements in psychological well-being. “The goals were quite well met. I still have a large lump of anxiety in my stomach, but being here has taken the edge off the darkest part, which is great.” (P14) Even in cases where immediate change was limited, participants emphasized the expected long-term benefits. “My general well-being is the same, but I believe this helps in the long run and helps to cope with what is happening here and now, which also benefits both short- and long-term outcomes.” (P7) The impact of the BA stay on well-being was also influenced by participants’ mental state at admission; those with more severe symptoms experienced limitations in fully benefiting from the offered interventions. “I need to seek help earlier because poor sleep, destructive thoughts, and self-harm need to be interrupted. It is in the contract when I should seek help, my own fault” (P32). The importance of seeking BA in a timely manner was frequently highlighted, as delaying admission could increase the risk of further deterioration. However, results indicate that participants sometimes struggled to assess independently whether their current state warranted a BA stay. During 47% of admissions, the full planned duration of three days was utilized. Nevertheless, three days were not always perceived as sufficient for recovery. Based on this, participants expressed differing preferences: some requested longer stays, whereas others were satisfied with shorter or earlier discharge from BA. Resultatdiskussion The main finding of this study indicates that the combination of a supportive environment, responsive and proactive staff interactions, and a balance between independence and offered support is crucial for the perceived helpfulness of BA. A central aspect that emerges is how the physical and psychosocial environment, together with staff attitudes and availability, influences the sense of safety and support during the care episode. The importance of in-depth conversations, rather than superficial interactions under stressful conditions, was highlighted as pivotal for wellbeing. The perceived effectiveness of the BA stay is therefore not solely dependent on the efforts of the healthcare staff but also on the individual’s capacity and opportunity to actively engage in the planned care and to take responsibility in accordance with their daily condition. The results of this study indicate that BA is perceived to contribute to the restoration of balance in daily life by reducing demands and providing an opportunity to distance oneself from everyday stressors within a safe and low-stimulation environment. This environment, in combination with access to human presence, reduced external stimuli, and opportunities for rest and recovery, was experienced as particularly supportive. These findings are consistent with previous research describing BA as an intervention that promotes psychological safety and facilitates recovery (28, 30, 35–36, 38–39, 50–52). In the present study, the need for a low-stimulation care environment emerged as particularly central to the experience of calm, while the importance of being seen and acknowledged by staff was highlighted as crucial for the sense of security during BA. A respectful and responsive approach is emphasized as central to a safe and supportive BA experience (52–53). In the present study, several evaluations highlighted a lack of proactive contact from staff, which contributed to feelings of being “forgotten.” Many participants reported difficulties initiating support themselves, a dynamic that risks further isolation. Similar patterns have been reported in other studies, where staff sometimes prioritize other tasks or patients, resulting in BA users feeling overlooked and lacking adequate attention (32,42,54). Being left unattended when staff attend to other urgent priorities can evoke feelings of neglect (30). These findings should also be understood in the context of emotional dysregulation and interpersonal difficulties, which can make it challenging for individuals to express or articulate their needs. Expectations that patients themselves should initiate support may therefore undermine the experience of safety and trust in care (55–56). It is important to note that NSSI often functions as a short-term strategy for affect regulation when other forms of communication fail (4–6, 55). For individuals engaging in NSSI, restrictions on self-harming behaviors in care settings may be experienced as the removal of a coping strategy, potentially affecting both wellbeing and self-perception (44). Within BA, NSSI is not permitted, as the goal is to facilitate the processing of emotions through alternative strategies, and to reframe self-harm as an expression of underlying psychological pain rather than a solution (21, 57). In this study, participants highlighted the importance of in-depth conversations to articulate and process their emotional state during BA. Superficial discussions in stressful environments were not experienced as helpful; conversations needed to be conducted with trust and by staff perceived as reliable. Similar findings have been reported elsewhere, indicating that conversations with trusted staff can facilitate emotional processing, support the management of difficult feelings, and help interrupt negative thought patterns (28, 41). The combination of patients’ difficulties in expressing needs and the challenges inherent in staff work environments suggests that BA should be understood both as a physical environment providing calm and safety, and as a relational intervention in which staff offer active but low-intensity presence. Peer support may further address key needs, such as feeling seen, heard, and understood, while promoting a sense of security (58). Peer supporters can provide empathy based on lived experience and support the recovery process (59). For successful implementation, however, clear role descriptions, continuity, and a balance between crisis stabilization and recovery focus are required. Furthermore, the needs of peer supporters themselves must be considered, and it must be clear that they do not possess professional therapeutic skills to conduct in-depth or emotionally complex conversations. The opportunity to be listened to and to experience safety is a central factor for positive care experiences across psychiatric inpatient care, underscoring the importance of respectful interactions and tailored care strategies (60–61). The results of this study indicate that, on average, the quality of staff interactions was rated as 8 on a numerical scale from 1 to 10. Positive experiences of staff interactions were associated with accessibility, understanding, and attentive listening. Conversely, difficulties arose when staff did not notice or inquire about BA users’ wellbeing or proactively initiate contact. This led some participants to refrain from seeking support out of concern for taking staff time away from other patients or not wanting to disturb staff, which could result in self-isolation in their rooms. Although BA has been shown to improve the care relationship between patients and staff (35), individuals with emotional dysregulation and NSSI in standard psychiatric inpatient care are often experienced as emotionally demanding, as they can evoke feelings of helplessness, anxiety, and exhaustion in staff (62). With repeated self-harming behaviors, staff attitudes may shift from understanding to irritation or frustration, contributing to stigmatization and labeling of patients as “demanding” or “manipulative” (17, 62–63). Since BA is frequently provided within the same wards as regular inpatient care, there is a risk that previously negative attitudes toward individuals with emotional dysregulation and NSSI may influence the care environment. These findings underscore the need for continuous training and supervision to ensure respectful and supportive interactions in the BA context (60–62). The findings of this study indicate that it is crucial for both conversations and activities to be adapted to the individual’s daily condition and offered in a manner that does not require the person to take full responsibility for initiating them. This aligns with previous findings, which emphasize the importance of designing support in a way that does not place additional demands on the patient (33). Participation in care should be understood as a dynamic interaction in which patients are given opportunities to engage while also understanding the structures that shape the care environment (64). Previous research, as well as the results of this study, suggest that participation is not solely about being active, but also about being offered the opportunity to choose how much responsibility one can manage. Patients’ sense of safety in interactions with healthcare staff emerged as a key factor, as feeling secure enables individuals to express themselves and be authentic (26, 65). Although many participants in this study found it challenging to initiate contact for conversations and activities themselves, it was also experienced as empowering to take responsibility for their own process. Increased personal responsibility was perceived as supportive of psychological wellbeing (28, 66). The ability to engage in planned activities according to daily condition, and in some cases manage one’s own medication, was also described as strengthening (35). At the same time, participants reported that in certain admissions, it felt beneficial to be relieved of responsibility for medication management when thoughts of overdose or self-harm were present. Similarly, those who do not manage their medication at home found it challenging to do so in the ward, which has also been noted in previous research (26). These findings highlight the need for a balance between personal responsibility and receiving care. Given that one of the aims of BA is to provide a time-out and opportunity for recovery, there is a need to discuss how individuals with persistent self-harming thoughts or difficulties assuming responsibility can be best supported within BA (22, 26, 31). This points to a need for increased person-centeredness, where daily condition guides how much responsibility the patient is expected to assume (64, 66). The results of this study indicate that initiating activities can be challenging when energy is low, staff are unavailable, or it is unclear which activities are planned (64, 66). Moreover, some admissions were primarily characterized by a need for rest rather than engagement, depending on the patient’s mental state. Previous research has described BA as a care approach grounded in person-centered principles, which can strengthen several important dimensions of patient participation and autonomy (26, 31, 33), consistent with broader person-centered care frameworks (64). This study confirms previously documented challenges associated with BA, such as difficulties seeking help, prior negative care experiences, and uncertainty about one’s own care needs (26, 32, 35, 52). For BA to contribute to improved health and more sustainable lifestyle outcomes, it must be tailored to each patient’s unique situation, resources, and mental state (26, 52). BA must be experienced as both accessible and supportive (21). Actively involving patients in their care is essential to ensure that care meets their needs, promotes normalization of behaviors, and helps create meaningful daily routines (64, 67). The results indicate that BA was perceived as helpful in only 66% of admissions. The relatively low proportion of patients reporting the care as beneficial may be related to the recurrent observation that patients often seek BA only after their mental health has significantly deteriorated (26). When admissions occur too late, patients experience difficulties completing planned activities, both due to a lack of energy and because they have trouble remembering what is included in their individual care plan. Similar challenges have previously been linked to perceptions of high demands within BA, which can contribute to additional stress for patients who are already vulnerable (26–27). Barriers that delay seeking BA may result in further deterioration of the patient’s condition before support is received (31). It is important to consider that individuals with mental health difficulties may find it challenging to express their needs or to assess when support is required (68). From a person-centered care perspective, both participation and autonomy are emphasized, with the patient’s capacities and preferences placed at the center (64, 67). These aspects are influenced not only by the care environment but also by the relationship between the patient and the staff (22, 64). Applying this principle in discussions about BA, addressing both challenges in seeking care and potential solutions, can strengthen patients’ ability to use BA in a more preventative and tailored manner (21, 26, 31, 69). In summary, BA appears to be a dynamic form of care that requires a nuanced balance between support and independence. The degree of responsibility and relief needs to be continuously adapted to the individual’s current needs and daily condition, while simultaneously safeguarding the patient’s autonomy and self-determination. METHODOLOGICAL DISCUSSION Data were collected using evaluation questionnaires comprising both open-ended questions, answered in writing, and items rated on numerical scales from 1 to 10 (where 1 = not at all and 10 = completely agree). To ensure that the open-ended questions were neutral, comprehensible, and sufficiently broad to allow nuanced responses, they were designed to capture participants’ experiences of the most central aspects of BA (70). The written responses were considered rich and detailed, with the total corpus encompassing approximately 400 pages of text. A challenge in analyzing written responses is the difficulty of fully interpreting participants’ intended meaning, as the absence of follow-up questions or opportunities for elaboration may increase the risk of misinterpretation (71). However, only two responses were deemed difficult to interpret. Of the 76 patients who completed the questionnaire, 68 were women, seven were men, and one identified as another gender. This gender distribution may reflect that women display higher rates of NSSI behaviors than men, both in clinical and non-clinical populations (72). In total, 225 evaluations were collected between 2018 and 2025. It should be noted as a potential limitation that some patients completed the evaluation multiple times. However, each evaluation represents a unique admission, and data were collected over an extended period, thus providing insight into experiences of BA in a broader context beyond individual patients. The numerical ratings were processed solely through percentage calculations. These results were subsequently mapped to the categories that emerged during the analysis phase (46). To avoid bias from the researchers’ preconceptions, discussions were held among the authors until consensus was reached regarding the categorization of results (45). To ensure confirmability, the analysis was text-centered, retaining BA users’ own expressions and responses as much as possible. Throughout the analysis process, content was continuously discussed, and the procedure involved an iterative movement between the evaluations and the development of categories to ensure that no relevant data were overlooked, a common challenge in conventional content analysis (46). By thoroughly describing the contextual conditions of the study, the results can be considered transferable to similar settings (45). CONCLUSION BA emerges as a dynamic form of care in which the balance between support and autonomy, as well as between responsibility and relief, must be continuously adapted to the individual’s current needs and daily condition. A calm and safe care environment, combined with available and validating staff, provides the conditions necessary for recovery. Participants’ difficulties in expressing needs and requesting support, often related to previous challenges in emotion regulation, underscore the importance of in-depth and validating conversations to facilitate the verbalization of feelings. BA thus functions both as a physical and relational form of care, where staff presence, active yet low-intensity, together with opportunities for activity and rest, fosters safety and dignity. BA is perceived as most helpful when accessed early and when the interplay between support and self-responsibility is characterized by a responsive, respectful, and proactive approach. Clinical Implications The findings suggest that staff knowledge of BA, combined with a professional and validating approach, is central to ensuring that BA is experienced as supportive. A safe and calm care environment appears crucial for patients’ rest and recovery. Staff need to attend to and prioritize patients utilizing BA to the same extent as other patients, even during periods of high workload on the ward. Furthermore, in-depth and validating conversations, combined with a clear and individually tailored balance between patient responsibility and need for support, should be considered throughout the BA stay. Declarations Ethics approval and consent to participate: The study was approved by the Swedish Ethical Review Authority (Ref. No. 2022–01530-02). Consent for publication: Written and oral informed consent was obtained from all participants. The information provided stated that the study would be published in a peer-reviewed international scientific journal. Availability of data and materials: The datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions: All authors meet the criteria for authorship: Specifically: (1) SH made substantial contributions to the conception and design of the study; (2) SH was responsible for data collection; (3) SH, RH, FG, and FB contributed to the analysis and interpretation of the data; (4) SH, RH, FG, and FB were involved in drafting the manuscript or critically revising it for important intellectual content; and (5) SH, RH, FG, and FB approved the final version of the manuscript to be published. Acknowledgements The authors would like to thank all participants who took part in the study and generously shared their knowledge and perspectives by completing the evaluations. The manuscript was proofread by a professional native English speaker. 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The prevalence of NSSI may be as high as 20\u0026ndash;30% in vulnerable populations, including adolescents and young adults, individuals in forensic and correctional settings, and psychiatric patients (2). Among individuals seeking psychiatric care, approximately 50% report a history of NSSI or suicide attempts (3).\u003c/p\u003e \u003cp\u003eUnderstanding the underlying reasons for NSSI is essential for the development of more effective treatment interventions (2). Individuals who engage in NSSI often exhibit intense emotional reactivity alongside emotional inhibition and difficulties in understanding and regulating emotions using adaptive strategies (4). Although the psychological processes leading to self-injurious behaviour are complex and multifaceted, NSSI may serve multiple functions (4\u0026ndash;6), including emotion regulation, communication of distress, and the modulation of interpersonal relationships (4\u0026ndash;7). Females are more likely to engage in NSSI to alleviate negative emotions, enact self-punishment, or as a cry for help, whereas males more often associate NSSI with anger or the use of psychoactive substances (8). Thus, both emotional and social vulnerabilities shape the meaning and function of NSSI for the individual (2).\u003c/p\u003e \u003cp\u003eRegardless of the form of self-injury, risk-prevention measures are a priority within psychiatric care. For individuals with NSSI, outpatient psychological treatment has demonstrated the greatest effectiveness (9). Such treatments primarily aim to modify maladaptive cognitive patterns and enhance emotion regulation to prevent destructive behaviours (10). Dialectical behaviour therapy, mentalization-based therapy, and schema therapy are among the interventions with the strongest evidence for reducing NSSI (11).\u003c/p\u003e \u003cp\u003eDespite this evidence, access to psychological treatment remains insufficient, and individuals with NSSI continue to be high users of inpatient psychiatric care (12). Hospital admissions are often related to severe anxiety, chaotic life circumstances, and suicidal ideation (13\u0026ndash;14), as well as severe self-injurious behaviour, intentional poisoning, or other forms of injury, with or without suicidal intent (15\u0026ndash;17). The longstanding lack of evidence-based inpatient interventions has frequently resulted in prolonged hospitalizations and the use of coercive measures (15\u0026ndash;17), which may undermine patient autonomy and contribute to poorer mental health outcomes (18).\u003c/p\u003e \u003cp\u003eTo reduce prolonged hospitalizations among individuals with NSSI, a short-term inpatient care model known as \u003cem\u003eBrief Admission\u003c/em\u003e (BA) has been developed. BA complements outpatient care and may be used when individuals experience severe anxiety, self-injury urges, or suicidal ideation (19\u0026ndash;24) In contrast to conventional psychiatric inpatient care, BA is initiated by the individual (25) and offers a brief stay of one to three days aimed at encouraging help-seeking before self-injury or suicidal behaviour occurs (26\u0026ndash;30). During BA, individuals are provided with rest, regular meals, and sleep, which may reduce NSSI while promoting autonomy and self-care (28, 30\u0026ndash;31).\u003c/p\u003e \u003cp\u003eResearch indicates predominantly positive experiences of BA among users, relatives, and healthcare professionals. Both patients and staff report that BA shifts the focus of care toward recovery and well-being rather than solely symptom reduction, as is often the case in traditional inpatient care (21, 28\u0026ndash;29, 32). Healthcare professionals have described BA as a paradigm shift toward shared responsibility between staff and patients (22), enhancing patient autonomy and self-determination (22, 25). Nurses also report strengthened therapeutic relationships and more person-centred care (21\u0026ndash;22, 25). BA has been found helpful in managing self-injury urges and reducing isolation (31\u0026ndash;32), with decreases in self-injury frequency and anxiety and improvements in self-rated quality of life during admission (33\u0026ndash;35). While total inpatient days may remain unchanged, BA is associated with shorter individual admissions (23, 34, 36). Overall, BA appears to be an acceptable care model that supports responsibility-taking while enabling individuals to maintain daily routines, work, and social relationships (28, 30, 35\u0026ndash;38). BA has proven to be particularly effective for individuals with more severe functional impairments (38), especially when combined with other psychological interventions (32, 40).\u003c/p\u003e \u003cp\u003eRelatives report increased reassurance from knowing that BA is available, which may reduce caregiver burden and anxiety (27, 41\u0026ndash;42). This is echoed by BA users, who perceive that seeking BA alleviates strain on significant others (32). Including relatives in the BA process may further reduce burden and create respite for both parties (41\u0026ndash;42).\u003c/p\u003e \u003cp\u003eDespite its advantages, nurses have reported challenges in trusting patients\u0026rsquo; capacity to assume responsibility for their own care (25), reflecting a shift from historically paternalistic care models. Recent studies also indicate that some individuals hesitate to seek BA due to negative prior experiences of psychiatric inpatient care or fear of being questioned or denied access (26, 29\u0026ndash;31). Difficulties in assessing one\u0026rsquo;s own mental state may further delay help-seeking, sometimes resulting in symptom severity that precludes BA eligibility (31, 35). Additionally, exposure to other patients with similar difficulties during BA may be triggering for some individuals (29). For BA to effectively promote healthier behaviours, healthcare professionals must be aware of and actively address factors that hinder health-promoting processes (26).\u003c/p\u003e \u003cp\u003eIndividuals with NSSI experience preventive interventions in psychiatric care differently, depending on the function self-injury serves (43\u0026ndash;44). To ensure both effectiveness and person-centredness, interventions such as BA should be individually tailored and continuously evaluated to identify strengths and areas for improvement in care quality (20, 38). Thus, the aim of this study was to explore individuals\u0026rsquo; subjective experiences of short-term inpatient admissions through Brief Admission.\u003c/p\u003e"},{"header":"METHODS","content":"\n\u003ch3\u003eDesign\u003c/h3\u003e\n\u003cp\u003eA qualitative design with an inductive approach was employed, as this methodology allowing for an open exploration of subjective experiences and to identifying emerging patterns and relationships. (45\u0026ndash;46).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eSince 2018, an ongoing research project in a region in southern Sweden has been conducted to evaluate Brief Admission (BA). At the initiation of the project, an evaluation form was developed by SH in collaboration with BA responsible staff, with the aim of assessing patients\u0026rsquo; experiences of care during BA admissions (Appendix 1). In total, 141 patients with an active BA contract provided written informed consent to participate in the project. All consenting participants were offered the opportunity to complete an evaluation following each BA admission, focusing on their experiences and perceptions of the BA care period.\u003c/p\u003e \u003cp\u003eThe evaluations consisted of seven open-ended questions addressing experiences of the admission, engagement in activities, aspects perceived as most helpful during the stay, experiences of the BA room, perceptions of staff interactions, the impact of the admission on well-being, and suggestions for potential improvements. In addition, three items assessed perceived helpfulness of BA care, perceptions of staff treatment, and the extent to which BA-related goals were achieved during the admission. These items were rated on numerical scales ranging from 1 to 10, where 1\u0026thinsp;=\u0026thinsp;not at all and 10\u0026thinsp;=\u0026thinsp;completely agree.\u003c/p\u003e \u003cp\u003eData collection took place between June 2018 and December 2025 and comprises 225 evaluations completed by a total of 76 patients, of whom 68 were women, seven men, and one identified as non-binary. The mean age of participants was 32.5 years (range 20\u0026ndash;55 years). More than four psychiatric diagnoses were reported by 55% of participants. The most common diagnoses were borderline personality disorder (66%), depression (42%), ADHD and/or autism spectrum disorder (42%), and post-traumatic stress disorder (38%). Regarding length of stay, the full three-day BA admission was utilized in 47% of admissions, two days in 29%, and one day in 25% of admissions. Each evaluation corresponded to a specific BA admission.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data were analysed using conventional qualitative content analysis (46). The analytic process was inductive, with findings derived from the data rather than from pre-existing categories or theoretical frameworks (45).\u003c/p\u003e \u003cp\u003eAll evaluations were initially read carefully and repeatedly to achieve an overall understanding of the material. Preliminary impressions and reflections were documented to support the subsequent analytic process. All written responses were then compiled into a single document and read as a whole to identify salient experiences within the data. Text segments considered relevant to the study aim were identified, condensed, and coded to capture their essential meaning.\u003c/p\u003e \u003cp\u003eCodes were compared based on similarities and differences and organised into an initial coding scheme comprising eleven subcategories. Subcategories that described the same phenomenon from different perspectives were subsequently grouped into broader categories. The analysis was iterative and involved continuous movement between the original text, codes, and emerging categories. Throughout the process, ongoing analytical discussions were held regarding the content of the text, the meaning of the categories, and their interrelationships. This process resulted in two main categories with six associated subcategories. The final step of the analysis involved reviewing the categories in relation to the original data to ensure that no essential meanings were lost (46).\u003c/p\u003e \u003cp\u003eResponses to the evaluation items in which participants rated their experiences were summarised as percentage data and are presented in the Results section under the relevant categories.\u003c/p\u003e \u003cp\u003eTo enhance the credibility of the findings, illustrative quotations from the evaluations are presented in connection with each subcategory (45).\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003e The study was approved by the Swedish Ethical Review Authority in Link\u0026ouml;ping (Ref. No. 2022\u0026ndash;01530-02) and conducted in accordance with the ethical principles of the Declaration of Helsinki for research involving human participants (47). The handling of participants\u0026rsquo; personal data complied with the General Data Protection Regulation (GDPR) and with established recommendations for ethical data management in human sciences research (48).\u003c/p\u003e \u003cp\u003e All participants were aged 18 years or older and provided informed, voluntary consent after receiving both oral and written information about the study aims, the voluntary nature of participation, and their right to withdraw at any time without providing a reason. Participants also consented to the publication of anonymised data.\u003c/p\u003e \u003cp\u003e The study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (49). A clinical trial registration number was not applicable.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe results are presented according to two main categories, each with three associated subcategories, to provide a detailed and nuanced understanding of the study material.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of categories and subcategories, developed from the evaluations of Brief admission, according to the conventional content analysis (44).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eCATEGORY\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eSUBCATEGORY\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eTHE CARING ENCOUNTER\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e• \u003cem\u003eSupportive Environments as a Basis for Seeking BA\u003c/em\u003e\u003c/p\u003e \u003cp\u003e• \u003cem\u003eThe Importance of Staff Responsiveness and Understanding\u003c/em\u003e\u003c/p\u003e \u003cp\u003e• \u003cem\u003eThe Importance of Safe and Accessible Conversations\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e\u003cb\u003eMANAGING ONE’S OWN PROCESS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003e• \u003cem\u003eThe Role and Limitations of Activities During BA\u003c/em\u003e\u003c/p\u003e \u003cp\u003e• \u003cem\u003eIndependence and Support in Medication Management\u003c/em\u003e\u003c/p\u003e \u003cp\u003e• \u003cem\u003ePlanning and Utilizing the Brief Admission Stay\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eTHE CARING ENCOUNTER\u003c/h3\u003e\n\u003cp\u003eThis category highlights how the interaction between patients and healthcare staff constitutes the core of the caring experience. Respectful treatment, access to supportive conversations, and the sense of being seen and heard within a safe environment emerged as central elements of BA. Together, these components foster a sense of security in which both human and environmental support interact synergistically. When any of these elements are lacking, BA users may experience uncertainty and reduced confidence in the care process.\u003c/p\u003e\n\u003ch3\u003eSupportive Environments as a Basis for Seeking BA\u003c/h3\u003e\n\u003cp\u003eThe evaluations indicate that BA is primarily sought to obtain a change of environment, interrupt destructive thought patterns, and gain rest within a safe and supportive setting. Opportunities for structure and routine, as well as relief from everyday demands and burdens, were highlighted as particularly meaningful. This environment provides space for managing emotions in a more constructive manner, thereby reducing the risk of engaging in self-injurious behaviors.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“Being in an environment where I can talk with staff and where there are fewer stimuli makes it easier for me to rest.”\u003c/em\u003e (P61)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eThe evaluations highligth the significance of being met in a welcoming manner by staff who adhere to the contract and the content of the individual care plan. When staff lacked familiarity with the care mode, or when access to BA was limited due to bed availability, participants emphasized the importance of having alternative support options or courses of action available. Feeling that it is legitimate to seek BA, without experiencing guilt or the sense of taking someone else’s place, emerged as a crucial prerequisite for utilizing the service\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“It was helpful to know approximately when I could call back to ask about an available spot when it was occupied. It is beneficial to be allowed to schedule a time to call the same day it becomes available and attend once the previous person has left, so that one does not have to compete for the spot multiple times during the day and can ‘reserve’ it with the first confirmation.”\u003c/em\u003e (P47).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eHaving the opportunity to securely store personal belongings in a designated BA room was perceived as a positive aspect of the stay. Furthermore, being cared for in a room separated from the regular wards, furnished in a homelike manner, was reported to reduce exposure to potentially overwhelming stimuli and create conditions conducive to rest and relaxation. When the designated BA room was occupied and care was provided in a regular ward room, participants reported a negative impact on their overall perception and experience of care.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“I was placed in the wrong room. The BA room is nicer, with a bookshelf, desk, etc., and feels more homely, so this was lacking.”\u003c/em\u003e (P71).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eIn addition to a supportive environment, the evaluations highlighted that a fundamental trust in the BA model is a prerequisite for seeking and engaging with the service.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe Importance of Staff Responsiveness and Understanding\u003c/h2\u003e \u003cp\u003e Overall, participants reported high appreciation for staff interactions, with an average rating of 8 on a 1–10 numerical scale.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"Difficult to rate. I experience very good treatment from everyone, except one who barely greeted me and seemed visibly annoyed the few times I asked for help. Otherwise good ♥.\"\u003c/em\u003e (64)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003e Positive aspects of staff interactions included their demonstrated understanding of BA users’ situations and emotional states, as well as their willingness to listen when participants wished to share distressing thoughts. Conversely, when staff did not acknowledge or inquire about BA users’ well-being, participants reported feeling overlooked. The evaluations indicate that it is crucial for staff to be proactive and initiate contact, as many participants expressed difficulty in asking for support themselves, and not being noticed or validated was experienced as stressful. Some participants refrained from initiating contact due to concerns about taking time away from other patients or disturbing staff, which sometimes led to isolation in their room.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"Check in on me more often during the day, as I tend to withdraw when I feel bad instead of asking for help.\"\u003c/em\u003e (P39).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eExperiences of supervision varied, some participants desired more regular check-ins, while others felt disturbed by excessive oversight. Further the evaluations highlight how BA-users felt anxious when there were to many new staff on the ward, and felt that it was easier to initiate contact and establish a trusting relationship with staff they were familiar with.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\"Comforting and helpful because I know them and they know me.\"\u003c/em\u003e (P11)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003e Participants also expressed a desire for simpler ways to communicate with all staff when support or supervision was needed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe Importance of Safe and Accessible Conversations\u003c/h3\u003e\n\u003cp\u003eThe evaluations indicate that conversations during the BA stay were generally appreciated. These interactions were described as distracting, positive, and helpful, allowing participants to verbalize their emotional states. Furthermore, conversations were experienced as strengthening, encouraging, and validating. Humility and approachability from staff were highlighted as important factors that contributed to a sense of safety during discussions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I spoke with several staff members; they were kind and attentive.\"\u003c/em\u003e (70)\u003c/p\u003e \u003cp\u003eStaff availability for conversations was emphasized with 84% of the evaluations reporting that discussions took place during the BA stay. Feeling safe with the staff member conducting the conversation was considered important and was often related to familiarity with the staff.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\"I experienced a conversation with a specific person as the best.\"\u003c/em\u003e (72)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eThe results further show that it is important for conversations to be conducted privately, away from distractions, and that they should occur even if the ward environment is noisy or busy. Conversations conducted under time pressure were perceived as more stressful than helpful. Participants expressed a preference for staff to initiate conversations, with at least one discussion per day being desirable.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"I find it difficult to approach staff if they are busy. I would appreciate if staff asked me sometimes. They suggested that I leave a note if I wanted a conversation.\"\u003c/em\u003e (71)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003e Some participants reported that conversations were too brief or superficial and expressed a desire for deeper, more reflective discussions.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"Aside from admission and discharge meetings, there were no deeper conversations. Everyone is very nice, but I missed something more in-depth.\"\u003c/em\u003e (P14)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003e When conversations did not occur, it was not always due to staff being unavailable or lacking time; it could also result from the participant being occupied with other activities, away from the ward, or feeling too unwell to engage.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Okay, I wasn’t very receptive because I felt so bad.\"\u003c/em\u003e (P28)\u003c/p\u003e\n\u003ch3\u003eMANAGING ONE’S OWN PROCESS\u003c/h3\u003e\n\u003cp\u003eThis category highlights BA users’ perceptions of their own responsibility in adhering to the individualized BA plan and goals. It encompasses participation in scheduled activities and the management of medications independently during the BA stay. Collectively, these components emphasize personal accountability as an integral part of the caring process.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThe Role and Limitations of Activities During BA\u003c/h2\u003e \u003cp\u003eThe evaluations indicate that BA users engaged in various activities to support their well-being. Reported activities included resting under a weighted blanket, listening to music, going for walks, receiving tactile massage or NADA, and following the individualized crisis plan. Overall, planned activities were carried out in 68% of BA stays.\u003c/p\u003e \u003cp\u003eCarrying out activities could be challenging, as it was primarily the BA user’s responsibility to request support for interventions such as tactile massage, conversations, or walks. In 21% of the evaluations it was stated that, planned activities were not completed. Reasons for non-completion included the BA user’s current mental or physical state, insufficient energy, or a lack of time or space to perform the planned activities.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“I did not go for a walk; it was too difficult to get out, but otherwise I did what we had agreed on” (P14).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eAlthough initiating activities was largely the BA user’s responsibility, results indicate that staff availability and training could limit the implementation of activities listed in the individualized plan. When BA users requested alternative interventions, such as NADA or tactile massage, but these were not provided, they interpreted this as being burdensome and questioned whether they should have sought BA.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e“I received tactile massage on the first day (which was very beneficial), but on the second day there was no staff trained to provide it. That was unfortunate” (P28).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eEvaluations also reveal that spontaneous needs and wishes for activities arose during the BA stay. These included activities aimed at relaxation and rest, interaction with others, or simply leisure and enjoyment.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e“\u003cem\u003eI wished for more therapy. I know this is not a clinic, but something like that would have helped me. Even a small conversational contact could have encouraged me to open up… I would have liked group discussions or to play some games” (P70).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eMost participants reported feeling reassured by having planned activities outlined in the individualized plan, as this promoted and reinforced their sense of responsibility for managing their BA stay and well-being. However, some participants experienced difficulties remembering the activities they had documented in the plan, while others were uncertain about which activities could be carried out during the stay.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“I do not remember all planned activities, but I used the items on my crisis list that always work positively” (P34).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eIndependence and Support in Medication Management\u003c/h2\u003e \u003cp\u003eThe findings indicate that managing one’s own medication during the BA stay was generally experienced as functioning well and contributed to a sense of independence and self-efficacy.\u003c/p\u003e \u003cp\u003e \u003cem\u003e“It felt good to have control over it myself.”\u003c/em\u003e (60)\u003c/p\u003e \u003cp\u003eHowever, some participants reported challenges such as forgetting or losing track of time, which in turn led to missed medication. In these situations, staff provided reminders to support adherence. The evaluations further show that opportunities for independent medication management were not always available, particularly when participants were accommodated in rooms without lockable medication storage.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e“It felt good, but it was a bit difficult having to ask a nurse for my medication bag since I did not have the BA room but a regular room without a safe.”\u003c/em\u003e (P57).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eMost participants reported that medication management functioned well overall, although knowledge and experience regarding medication handling varied. Some participants did not manage their medications independently at home, which in some cases contributed to uncertainty among relatives.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“It works well, but my husband is nervous about sending so much medication with me. I am not allowed to manage my medication at home due to a suicide attempt.”\u003c/em\u003e (P14).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eIn such cases, responsibility for medication management was transferred to staff. Some participants also reported that it would have been relieving to be relieved of this responsibility during the BA stay. This was particularly relevant when participants experienced a deterioration in mental state or an increase in self-destructive or suicidal thoughts during the admission.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“I was actually in a state where I needed to place the responsibility on someone else in order to get relief from all the suicidal and self-harm thoughts.”\u003c/em\u003e (P32)\u003c/p\u003e\u003cp\u003e \u003cem\u003e“It was fine, though difficult this time because I wanted to overdose on insulin, but it was handled well with the help of staff.”\u003c/em\u003e (P57)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePlanning and Utilizing the Brief Admission Stay\u003c/h2\u003e \u003cp\u003eThe evaluations indicate that BA was perceived as helpful in 66% of admissions. Participants reported that their individual needs were largely met during the stay, and that overall well-being was influenced by the combined experience of available interventions, such as conversations with staff, structured activities, and opportunities for rest.\u003c/p\u003e \u003cp\u003e \u003cem\u003e“It is great that this form of help exists!”\u003c/em\u003e (P7)\u003c/p\u003e \u003cp\u003eBA was appreciated as a form of care even when it did not lead to immediate or substantial improvements in psychological well-being.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“The goals were quite well met. I still have a large lump of anxiety in my stomach, but being here has taken the edge off the darkest part, which is great.”\u003c/em\u003e (P14)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eEven in cases where immediate change was limited, participants emphasized the expected long-term benefits.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e“My general well-being is the same, but I believe this helps in the long run and helps to cope with what is happening here and now, which also benefits both short- and long-term outcomes.”\u003c/em\u003e (P7)\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eThe impact of the BA stay on well-being was also influenced by participants’ mental state at admission; those with more severe symptoms experienced limitations in fully benefiting from the offered interventions.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e“I need to seek help earlier because poor sleep, destructive thoughts, and self-harm need to be interrupted. It is in the contract when I should seek help, my own fault” (P32).\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eThe importance of seeking BA in a timely manner was frequently highlighted, as delaying admission could increase the risk of further deterioration. However, results indicate that participants sometimes struggled to assess independently whether their current state warranted a BA stay. During 47% of admissions, the full planned duration of three days was utilized. Nevertheless, three days were not always perceived as sufficient for recovery. Based on this, participants expressed differing preferences: some requested longer stays, whereas others were satisfied with shorter or earlier discharge from BA.\u003c/p\u003e \u003cp\u003eResultatdiskussion\u003c/p\u003e \u003cp\u003eThe main finding of this study indicates that the combination of a supportive environment, responsive and proactive staff interactions, and a balance between independence and offered support is crucial for the perceived helpfulness of BA. A central aspect that emerges is how the physical and psychosocial environment, together with staff attitudes and availability, influences the sense of safety and support during the care episode. The importance of in-depth conversations, rather than superficial interactions under stressful conditions, was highlighted as pivotal for wellbeing. The perceived effectiveness of the BA stay is therefore not solely dependent on the efforts of the healthcare staff but also on the individual’s capacity and opportunity to actively engage in the planned care and to take responsibility in accordance with their daily condition.\u003c/p\u003e \u003cp\u003eThe results of this study indicate that BA is perceived to contribute to the restoration of balance in daily life by reducing demands and providing an opportunity to distance oneself from everyday stressors within a safe and low-stimulation environment. This environment, in combination with access to human presence, reduced external stimuli, and opportunities for rest and recovery, was experienced as particularly supportive. These findings are consistent with previous research describing BA as an intervention that promotes psychological safety and facilitates recovery (28, 30, 35–36, 38–39, 50–52). In the present study, the need for a low-stimulation care environment emerged as particularly central to the experience of calm, while the importance of being seen and acknowledged by staff was highlighted as crucial for the sense of security during BA.\u003c/p\u003e \u003cp\u003eA respectful and responsive approach is emphasized as central to a safe and supportive BA experience (52–53). In the present study, several evaluations highlighted a lack of proactive contact from staff, which contributed to feelings of being “forgotten.” Many participants reported difficulties initiating support themselves, a dynamic that risks further isolation. Similar patterns have been reported in other studies, where staff sometimes prioritize other tasks or patients, resulting in BA users feeling overlooked and lacking adequate attention (32,42,54). Being left unattended when staff attend to other urgent priorities can evoke feelings of neglect (30). These findings should also be understood in the context of emotional dysregulation and interpersonal difficulties, which can make it challenging for individuals to express or articulate their needs. Expectations that patients themselves should initiate support may therefore undermine the experience of safety and trust in care (55–56). It is important to note that NSSI often functions as a short-term strategy for affect regulation when other forms of communication fail (4–6, 55). For individuals engaging in NSSI, restrictions on self-harming behaviors in care settings may be experienced as the removal of a coping strategy, potentially affecting both wellbeing and self-perception (44). Within BA, NSSI is not permitted, as the goal is to facilitate the processing of emotions through alternative strategies, and to reframe self-harm as an expression of underlying psychological pain rather than a solution (21, 57). In this study, participants highlighted the importance of in-depth conversations to articulate and process their emotional state during BA. Superficial discussions in stressful environments were not experienced as helpful; conversations needed to be conducted with trust and by staff perceived as reliable. Similar findings have been reported elsewhere, indicating that conversations with trusted staff can facilitate emotional processing, support the management of difficult feelings, and help interrupt negative thought patterns (28, 41).\u003c/p\u003e \u003cp\u003eThe combination of patients’ difficulties in expressing needs and the challenges inherent in staff work environments suggests that BA should be understood both as a physical environment providing calm and safety, and as a relational intervention in which staff offer active but low-intensity presence. Peer support may further address key needs, such as feeling seen, heard, and understood, while promoting a sense of security (58). Peer supporters can provide empathy based on lived experience and support the recovery process (59). For successful implementation, however, clear role descriptions, continuity, and a balance between crisis stabilization and recovery focus are required. Furthermore, the needs of peer supporters themselves must be considered, and it must be clear that they do not possess professional therapeutic skills to conduct in-depth or emotionally complex conversations. The opportunity to be listened to and to experience safety is a central factor for positive care experiences across psychiatric inpatient care, underscoring the importance of respectful interactions and tailored care strategies (60–61).\u003c/p\u003e \u003cp\u003eThe results of this study indicate that, on average, the quality of staff interactions was rated as 8 on a numerical scale from 1 to 10. Positive experiences of staff interactions were associated with accessibility, understanding, and attentive listening. Conversely, difficulties arose when staff did not notice or inquire about BA users’ wellbeing or proactively initiate contact. This led some participants to refrain from seeking support out of concern for taking staff time away from other patients or not wanting to disturb staff, which could result in self-isolation in their rooms. Although BA has been shown to improve the care relationship between patients and staff (35), individuals with emotional dysregulation and NSSI in standard psychiatric inpatient care are often experienced as emotionally demanding, as they can evoke feelings of helplessness, anxiety, and exhaustion in staff (62). With repeated self-harming behaviors, staff attitudes may shift from understanding to irritation or frustration, contributing to stigmatization and labeling of patients as “demanding” or “manipulative” (17, 62–63). Since BA is frequently provided within the same wards as regular inpatient care, there is a risk that previously negative attitudes toward individuals with emotional dysregulation and NSSI may influence the care environment. These findings underscore the need for continuous training and supervision to ensure respectful and supportive interactions in the BA context (60–62).\u003c/p\u003e \u003cp\u003eThe findings of this study indicate that it is crucial for both conversations and activities to be adapted to the individual’s daily condition and offered in a manner that does not require the person to take full responsibility for initiating them. This aligns with previous findings, which emphasize the importance of designing support in a way that does not place additional demands on the patient (33). Participation in care should be understood as a dynamic interaction in which patients are given opportunities to engage while also understanding the structures that shape the care environment (64). Previous research, as well as the results of this study, suggest that participation is not solely about being active, but also about being offered the opportunity to choose how much responsibility one can manage. Patients’ sense of safety in interactions with healthcare staff emerged as a key factor, as feeling secure enables individuals to express themselves and be authentic (26, 65).\u003c/p\u003e \u003cp\u003e Although many participants in this study found it challenging to initiate contact for conversations and activities themselves, it was also experienced as empowering to take responsibility for their own process. Increased personal responsibility was perceived as supportive of psychological wellbeing (28, 66). The ability to engage in planned activities according to daily condition, and in some cases manage one’s own medication, was also described as strengthening (35). At the same time, participants reported that in certain admissions, it felt beneficial to be relieved of responsibility for medication management when thoughts of overdose or self-harm were present. Similarly, those who do not manage their medication at home found it challenging to do so in the ward, which has also been noted in previous research (26). These findings highlight the need for a balance between personal responsibility and receiving care.\u003c/p\u003e \u003cp\u003eGiven that one of the aims of BA is to provide a time-out and opportunity for recovery, there is a need to discuss how individuals with persistent self-harming thoughts or difficulties assuming responsibility can be best supported within BA (22, 26, 31). This points to a need for increased person-centeredness, where daily condition guides how much responsibility the patient is expected to assume (64, 66). The results of this study indicate that initiating activities can be challenging when energy is low, staff are unavailable, or it is unclear which activities are planned (64, 66). Moreover, some admissions were primarily characterized by a need for rest rather than engagement, depending on the patient’s mental state.\u003c/p\u003e \u003cp\u003ePrevious research has described BA as a care approach grounded in person-centered principles, which can strengthen several important dimensions of patient participation and autonomy (26, 31, 33), consistent with broader person-centered care frameworks (64). This study confirms previously documented challenges associated with BA, such as difficulties seeking help, prior negative care experiences, and uncertainty about one’s own care needs (26, 32, 35, 52). For BA to contribute to improved health and more sustainable lifestyle outcomes, it must be tailored to each patient’s unique situation, resources, and mental state (26, 52). BA must be experienced as both accessible and supportive (21). Actively involving patients in their care is essential to ensure that care meets their needs, promotes normalization of behaviors, and helps create meaningful daily routines (64, 67).\u003c/p\u003e \u003cp\u003eThe results indicate that BA was perceived as helpful in only 66% of admissions. The relatively low proportion of patients reporting the care as beneficial may be related to the recurrent observation that patients often seek BA only after their mental health has significantly deteriorated (26). When admissions occur too late, patients experience difficulties completing planned activities, both due to a lack of energy and because they have trouble remembering what is included in their individual care plan. Similar challenges have previously been linked to perceptions of high demands within BA, which can contribute to additional stress for patients who are already vulnerable (26–27). Barriers that delay seeking BA may result in further deterioration of the patient’s condition before support is received (31).\u003c/p\u003e \u003cp\u003eIt is important to consider that individuals with mental health difficulties may find it challenging to express their needs or to assess when support is required (68). From a person-centered care perspective, both participation and autonomy are emphasized, with the patient’s capacities and preferences placed at the center (64, 67). These aspects are influenced not only by the care environment but also by the relationship between the patient and the staff (22, 64). Applying this principle in discussions about BA, addressing both challenges in seeking care and potential solutions, can strengthen patients’ ability to use BA in a more preventative and tailored manner (21, 26, 31, 69).\u003c/p\u003e \u003cp\u003eIn summary, BA appears to be a dynamic form of care that requires a nuanced balance between support and independence. The degree of responsibility and relief needs to be continuously adapted to the individual’s current needs and daily condition, while simultaneously safeguarding the patient’s autonomy and self-determination.\u003c/p\u003e \u003c/div\u003e "},{"header":"METHODOLOGICAL DISCUSSION","content":"\u003cp\u003eData were collected using evaluation questionnaires comprising both open-ended questions, answered in writing, and items rated on numerical scales from 1 to 10 (where 1 = not at all and 10 = completely agree). To ensure that the open-ended questions were neutral, comprehensible, and sufficiently broad to allow nuanced responses, they were designed to capture participants’ experiences of the most central aspects of BA (70). The written responses were considered rich and detailed, with the total corpus encompassing approximately 400 pages of text. A challenge in analyzing written responses is the difficulty of fully interpreting participants’ intended meaning, as the absence of follow-up questions or opportunities for elaboration may increase the risk of misinterpretation (71). However, only two responses were deemed difficult to interpret.\u003c/p\u003e\u003cp\u003eOf the 76 patients who completed the questionnaire, 68 were women, seven were men, and one identified as another gender. This gender distribution may reflect that women display higher rates of NSSI behaviors than men, both in clinical and non-clinical populations (72). In total, 225 evaluations were collected between 2018 and 2025. It should be noted as a potential limitation that some patients completed the evaluation multiple times. However, each evaluation represents a unique admission, and data were collected over an extended period, thus providing insight into experiences of BA in a broader context beyond individual patients.\u003c/p\u003e\u003cp\u003eThe numerical ratings were processed solely through percentage calculations. These results were subsequently mapped to the categories that emerged during the analysis phase (46). To avoid bias from the researchers’ preconceptions, discussions were held among the authors until consensus was reached regarding the categorization of results (45). To ensure confirmability, the analysis was text-centered, retaining BA users’ own expressions and responses as much as possible. Throughout the analysis process, content was continuously discussed, and the procedure involved an iterative movement between the evaluations and the development of categories to ensure that no relevant data were overlooked, a common challenge in conventional content analysis (46). By thoroughly describing the contextual conditions of the study, the results can be considered transferable to similar settings (45).\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eBA emerges as a dynamic form of care in which the balance between support and autonomy, as well as between responsibility and relief, must be continuously adapted to the individual\u0026rsquo;s current needs and daily condition. A calm and safe care environment, combined with available and validating staff, provides the conditions necessary for recovery. Participants\u0026rsquo; difficulties in expressing needs and requesting support, often related to previous challenges in emotion regulation, underscore the importance of in-depth and validating conversations to facilitate the verbalization of feelings. BA thus functions both as a physical and relational form of care, where staff presence, active yet low-intensity, together with opportunities for activity and rest, fosters safety and dignity. BA is perceived as most helpful when accessed early and when the interplay between support and self-responsibility is characterized by a responsive, respectful, and proactive approach.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eThe findings suggest that staff knowledge of BA, combined with a professional and validating approach, is central to ensuring that BA is experienced as supportive. A safe and calm care environment appears crucial for patients\u0026rsquo; rest and recovery. Staff need to attend to and prioritize patients utilizing BA to the same extent as other patients, even during periods of high workload on the ward. Furthermore, in-depth and validating conversations, combined with a clear and individually tailored balance between patient responsibility and need for support, should be considered throughout the BA stay.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Swedish Ethical Review Authority (Ref. No. 2022\u0026ndash;01530-02).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten and oral informed consent was obtained from all participants. The information provided stated that the study would be published in a peer-reviewed international scientific journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors meet the criteria for authorship: \u0026nbsp;Specifically: (1) SH made substantial contributions to the conception and design of the study; (2) SH was responsible for data collection; (3) SH, RH, FG, and FB contributed to the analysis and interpretation of the data; (4) SH, RH, FG, and FB were involved in drafting the manuscript or critically revising it for important intellectual content; and (5) SH, RH, FG, and FB approved the final version of the manuscript to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants who took part in the study and generously shared their knowledge and perspectives by completing the evaluations. The manuscript was proofread by a professional native English speaker.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eInternational Society for the Study of Self-Injury (ISSS). What is self-injury? cited 2026 Jan: https://itriples.org/about-self-injury/what-is-self-injury/\u003c/li\u003e\n\u003cli\u003eTurner BJ, Chapman AL, Layden BK. Intrapersonal and interpersonal functions of non-suicidal self-injury: associations with emotional and social functioning. \u003cstrong\u003eSuicide Life Threat Behav\u003c/strong\u003e. 2012;42(1):36\u0026ndash;55. https://doi.org/10.1111/j.1943-278X.2011.00069.x\u003c/li\u003e\n\u003cli\u003eWaern M, Str\u0026ouml;msten L, Wiktorsson S, Runeson B, Renberg ES. Overlapping patterns of suicide attempts and non-suicidal self-injuries in adults: a prospective clinical cohort study. \u003cstrong\u003eJ Clin Psychiatry\u003c/strong\u003e. 2022;83(6):21m14330. https://doi.org/10.4088/JCP.21m14330\u003c/li\u003e\n\u003cli\u003eKlonsky ED, Glenn CR, Styer DM, Olino TM, Washburn JJ. The functions of nonsuicidal self-injury: converging evidence for a two-factor structure. \u003cstrong\u003eChild Adolesc Psychiatry Ment Health\u003c/strong\u003e. 2015;9:44. https://doi.org/10.1186/s13034-015-0073-4\u003c/li\u003e\n\u003cli\u003eLutz NM, Chamberlain SR, Grant JE, et al. Similarities and differences in the functions of non-suicidal self-injury (NSSI) across gender non-conforming and cisgender young adults. \u003cem\u003eJ Affect Disord\u003c/em\u003e. 2024;367:496-506. doi:10.1016/j.jad.2024.08.224\u003c/li\u003e\n\u003cli\u003eTaş Torun Y, Gul H, Yaylali FH, Gul A. Intra/interpersonal functions of non-suicidal self-injury in adolescents with major depressive disorder: the role of emotion regulation, alexithymia, and childhood traumas. \u003cstrong\u003ePsychiatry\u003c/strong\u003e. 2022;85(1):86\u0026ndash;99. https://doi.org/10.1080/00332747.2021.1989854\u003c/li\u003e\n\u003cli\u003eTaylor PJ, Jomar K, Dhingra K, Forrester R, Shahmalak U, Dickson JM. A meta-analysis of the prevalence of different functions of non-suicidal self-injury. \u003cstrong\u003eJ Affect Disord\u003c/strong\u003e. 2018;227:759\u0026ndash;769. https://doi.org/10.1016/j.jad.2017.11.073\u003c/li\u003e\n\u003cli\u003eMoloney F, Amini J, Sinyor M, Schaffer A, Lanct\u0026ocirc;t K, Mitchell RHB. 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Why open-ended survey questions are unlikely to support rigorous qualitative insights. \u003cstrong\u003eAcad Med\u003c/strong\u003e. 2018;93(3):347\u0026ndash;349. https://doi.org/10.1097/ACM.0000000000002088\u003c/li\u003e\n\u003cli\u003eKnipe D, Padmanathan P, Newton-Howes G, Chan LF, Kapur N. Suicide and self-harm. \u003cstrong\u003eLancet\u003c/strong\u003e. 2022;399(10338):1903\u0026ndash;1916. https://doi.org/10.1016/S0140-6736(22)00173-8\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Experiences, Content analysis, Non-suicidal self-injury, Brief Admission, Evaluation forms","lastPublishedDoi":"10.21203/rs.3.rs-8679770/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8679770/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBrief Admission (BA) is a complementary model of psychiatric inpatient care that allows individuals to initiate a short hospital stay of 1\u0026ndash;3 days on their own initiative. Previous research has generally shown that BA is perceived as a valued intervention by patients, healthcare professionals, and significant others, and that it may promote patient participation while enabling the maintenance of everyday activities and social relationships. However, some individuals experience difficulties in assessing their need for BA and feel uncertainty about seeking BA, often related to prior negative experiences of psychiatric inpatient care. To ensure that care is both effective and person-centred, interventions need to be continuously evaluated in order to identify both effective components and areas for improvement that may enhance care quality.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe aim of this study was to explore patients\u0026rsquo; subjective experiences of short inpatient stays within the context of BA.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA qualitative inductive design was employed. Data consisted of 225 evaluation forms completed by patients who had been admitted through BA between 2018 and 2025. The responses were analysed using conventional content analysis to gain an in-depth understanding of the phenomenon and to identify patterns and relationships within the data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe findings indicate that BA provides support and facilitates recovery when users experience staff as validating and are offered opportunities for dialogue. The importance of a calm environment, structured routines, and access to either activities or rest was emphasised. The results further suggest that BA is most appreciated when used at an early stage and when a balance is achieved between the individual\u0026rsquo;s need for support and their level of personal responsibility.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBA constitutes a dynamic form of care that requires continuous balancing between support and autonomy, as well as between responsibility and relief, tailored to the individual\u0026rsquo;s needs and daily condition.\u003c/p\u003e","manuscriptTitle":"Subjective Experiences of Receiving Short-Term Care Through Brief Admission: A Study Based on Post-Discharge Written Patient Evaluations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-16 14:50:11","doi":"10.21203/rs.3.rs-8679770/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-22T14:34:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T15:39:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T09:13:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-18T18:40:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T00:37:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107071758247293997864470715843913221722","date":"2026-04-13T20:42:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-10T11:35:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276127707971391608198885589292556201939","date":"2026-04-09T15:29:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61963933469903212324878976481792022142","date":"2026-04-09T10:03:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214652704968260115690585188734422905466","date":"2026-04-09T05:50:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"51837072442009074638766724543436478740","date":"2026-04-08T23:59:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T16:39:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263063606012343296977274163932932892929","date":"2026-04-08T15:58:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62815923523900841461296478359140811423","date":"2026-04-08T15:54:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333064810506283248634871173162856599360","date":"2026-04-08T15:40:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152937643787027977504950682414702292519","date":"2026-04-08T15:39:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-08T15:08:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-14T00:00:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-05T18:39:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T11:15:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2026-02-03T10:14:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ef280b84-bd7b-47f7-99da-6051ede26fd0","owner":[],"postedDate":"April 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T14:50:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-16 14:50:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8679770","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8679770","identity":"rs-8679770","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}