User participation and shared decision-making in adolescent mental healthcare: a qualitative study of healthcare professionals' perspectives

Background Most mental health problems occur in adolescence. There is increasing recognition of user participation and shared decision-making in adolescents’ mental healthcare. However, research in this field of clinical practice is still sparse. The objective of this study was to explore healthcare professionals’ perspectives on user participation, and opportunities for shared decision-making in Child and Adolescent Mental Health Service (CAMHS) inpatient units. Methods Healthcare professionals at CAMHS inpatient units participated in three focus group interviews. Fifteen participants with experience with user participation and shared decision-making were recruited from five hospitals in Norway. Results Five themes emerged: (1) involvement before admission; (2) sufficient time to feel safe; (3) individualized therapy; (4) access to meetings where decisions are made; and (5) changing professionals’ attitudes and practices. Conclusion User participation and shared decision-making require changes in workplace culture, and routines that allow for individualized mental health services that are adapted to adolescents’ needs. This calls for a flexible approach that challenges clinical pathways and short-stay hospital policies. The results of this study may inform further work on strengthening user participation and the implementation of shared decision-making.