Comprehensive treatment of psychological trauma patients: professional actors’ experiences of external framing factors and treatment characteristics in a Norwegian inpatient context

Background Evaluations of treatment of psychiatric patients often consist of comparisons of quantitative patient-level data pre- and post-treatment. This qualitative study explores the thoughts of different actors in contact with psychological trauma patients before, during, and/or after comprehensive treatment. The treatment consisted of physical activity, healthy nutrition, social support, and psychoeducation, in addition to pharmacology and psychotherapy. The study aim was to explore factors influencing the comprehensive treatment on trauma patients, from the perspective of various health-care professionals and representatives of voluntary organizations. Methods Individual semi-structured interviews were conducted with 11 informants, working in various mental healthcare organizations in Norway. Manifest content analysis was used to analyse the data. Results Two main categories emerged in the analysis; (1) External framing factors , underpinned by the two sub-categories, Referral thresholds and patient status , and Organizational aspects post-treatment , and (2) Treatment at the inpatient facility , underpinned by the sub-categories Patient participation and commitment , and Feeling safe and secure through treatment and beyond . The received responses indicated that the treatment was affected by the fact that patients referred to the inpatient facility were reported to often have more complex problems than previously. During treatment, patients’ preparedness and commitment to actively participate in the intense treatment were claimed to be important factors for treatment outcomes. Returning home after treatment tends to be a vulnerable phase, with little support from mental health care. According to the informants, there is currently no automatic follow-up care, or interorganizational collaboration between the actors. Conclusions According to the informants, the patients currently referred to the inpatient facility, more often have complex problems and physical ailments than before, and follow-up care after discharge seemed inadequate. Given the complexity in patients with long-term and severe trauma related mental health problems, it is important to consider more continuous care, including better follow-up care post-treatment. The absence of support and care when patients return home increases the risk of regression to old habits and mental illness.