Stian Biong

Diversity in causes and characteristics of drug-induced deaths in an urban setting

Aims: To assess demographic characteristics, treatment utilization and circumstances of death among those who died from drug-induced deaths in an urban setting and to identify possible subpopulations that should be targeted specifically to further develop preventive public health policies. Methods: Subjects (N = 231) who died, from drug-induced deaths, in the Norwegian capital Oslo (2006–2008) were identified through the National Cause of Death Registry. Data on toxicology, prison release and contact with health and social services in Oslo were collected. Results: Majority of cases were men (78%) and the mean age was 37 years. Nearly all cases (90%) were polydrug intoxications. Heroin was implicated in 67%. Residential address was the most common place of death (67%). Most cases (82%) had been in contact with health and social services in the year before death. Women were 4 years older, more often Oslo residents (82% vs. 64%) and fewer died from heroin intoxication. Non-Oslo residents were younger and more likely to have been found outdoors with heroin as the main intoxicant. Other identified subpopulations were those who died after prison release and those discharged from drug treatment. Conclusions: The findings suggest that the majority of cases could have been available for preventive measures through their contacts with health and social services. Yet, the heterogeneity among cases indicates that such measures need to be multifaceted. Finally, it is important for policymakers and health and social workers in various countries to consider subpopulations such as women and non-city residents when developing public health interventions to prevent overdose deaths.

The lived experience of stroke survivors with early depressive symptoms: A longitudinal perspective

Purpose The aim of the study was to describe the lived experience as it develops over time in stroke survivors suffering from early depressive symptoms. Method This paper presents a phenomenological hermeneutical interview-study of nine participants at 6, 12, and 18 months after stroke. Findings The participants related the depressive symptoms to the consequences of the stroke, and the experience of loss was crucial. Depressive symptoms was not meaningful on its own, but formed the backdrop of the experience of stroke. Our findings revealed three patterns of experience: (1) finding a restored self; (2) trapped in a different life; and (3) fighting to regain self. Two groups of stroke survivors are particularly vulnerable and should receive special attention: (a) old adults living alone; and (b) adults experiencing serious threats to their commitments such as to work, family, and children. Conclusion Depressive symptoms have a severe impact on life after stroke. Life circumstances, degree of residual impairment from a stroke, and social context were found to influence people to move along different paths. Older adults living alone and adults experiencing serious threat to their commitments should receive special attention, in terms of further research and in terms of follow-up in clinical practice. More studies investigating the experience of post-stroke depression (PSD) over time and the association between depressive symptoms and loss/grieving are needed. There is also a need for continued empirical research on the identification of effective interventions aimed at prevention or improved coping with PSD.

Relational hopes: A study of the lived experience of hope in some patients hospitalized for intentional self-harm

Hopelessness is a well-established predictor of suicide, and inspiring hope is an important goal in mental health care, but there are few studies of hope among persons with suicidal behavior. The aim of this study was to interpret the lived experience of hope in some patients hospitalized for intentional self-harm. Twelve persons that had engaged in suicidal behavior by ingesting an overdose of medication were interviewed shortly after hospitalization and asked to narrate about their hopes. The transcripts were analyzed using a phenomenological hermeneutic method inspired by Ricoeurs theory of interpretation. The naïve reading was one of hope being relational. The structural analysis identified three themes: hopes for life, hopes for death, and the act of hoping. We interpreted the common theme of the interviews as being definite and indefinite relational hopes for life and death. For clinicians, expressions of indefinite hopes may raise concerns about the low likelihood of fulfillment. However, the expression of indefinite hope may serve to avoid experiencing failure, disappointment, and hopelessness.

Young men's experiences of living with substance abuse and suicidal behaviour: Between death as an escape from pain and the hope of a life

The aim of the study was to illuminate the experiences of suicidal behaviour in young Norwegian men with long-term substance abuse and to interpret their narratives with regard to meaning. Data were collected using open-ended, in-depth interviews. A phenomenological hermeneutic approach, inspired by the philosophy of Ricoeur, was used to analyse the data. The naïve reading involved awareness of the perceived sense of pain and hope in the participants. In the structural analysis, three themes were identified: (1) the meaning of relating, (2) the meaning of reflecting and (3) the meaning of acting. A comprehensive understanding of data indicated that the meaning of living with suicidal behaviour could be understood as a movement between different positions of wanting death as an escape from pain and hope for a better life. Our conclusion is that suicidal behaviour in men with substance abuse is a communicative activity about the individuals lived experience of pain and hope. How the participants experienced and constructed masculinity influenced the suicidal behaviour. To reduce pain and create hope by being seen and confirmed in social relationships, and being helped to verbalize existential thoughts and openly discuss possible solutions, are of importance.

First-person experiences of recovery in co-occurring mental health and substance use conditions

This is the author’s version of the article published in Advances in Dual Diagnosis: Policy, practice and research in mental health and substance use. The article has been peer-reviewed, but does not include the publisher’s layout, page numbers and proof-corrections. Citation for the published paper: Brekke, E., Lien, L., Davidson, L. & Biong, S. (2017). First-person experiences of recovery in co-occurring mental health and substance use conditions. Advances in Dual Diagnosis, 10(1), 13-24. http://dx.doi.org10.1108/ADD-07-2016-0015

You never know what’s around the next corner: exploring practitioners ' hope inspiring practices

Purpose – Hope is regarded central to recovery in a broad range of health conditions including mental health and substance use problems. Still the phenomenon, along with its implications to research and practice, has gained limited attention. The purpose of this paper is to explore first-person accounts of how practitioners nurture and inspire hope. Design/methodology/approach – This qualitative study is part of a larger action research project. Data were collected using in-depth interviews with eight participants. The interviews were transcribed verbatim and analyzed applying thematic analysis. Findings – Hope was perceived as a central phenomenon to practitioners within mental health and substance use services. The following overarching themes were identified through thematic analysis: “Believing in oneself and others,” “Seeing and acknowledging opportunities” and “maneuvering towards hope.” Research limitations/implications – It seems that there is a need for extending knowledge in how practitioners ma...

A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 1. Patient characteristics at admission and referral

BackgroundCrisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the first paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on describing the characteristics of the patients at admission.MethodsThe study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009.ResultsAlthough diverse in their characteristics, the patients were over represented by females, young to middle aged, and people on public support. The patients were mostly referred to the team by self/family members and primary care physicians. At admission, depression was the most prevalent symptom, the overall intensity level of mental health problems was low, and most of the patients had long-standing mental health problems.ConclusionsSelf/family referral seems to be a critical route to receive services by CRTH teams as shown in our study, suggesting a need to examine policies that disallow this form of referral in some communities. The findings from our study show that the patients of the CRHT team, while mostly having long-standing mental health problems and had been receiving healthcare for them, did not have severe mental health problems at admission, although could have been in crises. There is a need for further studies to examine how people with severe mental health problems obtain services in time of crises, and to address the need to gain a greater understanding of the role of CRHT.

A shifting sense of being: A secondary analysis and comparison of two qualitative studies on young-onset dementia

The aim of the present study was to investigate and interpret metaphorical expressions of the lived experiences of everyday life in people with young-onset dementia (YOD) and to compare these findings with findings from an analysis via grounded theory to see if the second analysis adds more knowledge to the topic. In this secondary analysis of data, metaphors from 20 Norwegian men and women living with YOD were investigated. Using Stegers anthropological three-step method, three categories were identified: Sliding away, leaving traces, and all alone in the world. Comprehensively, we understood the metaphors as representing the participants’ shifting sense of being. The main findings of the study show that by analysing the data by combining and using both methods, more knowledge to the topic was added. Acknowledging metaphorical expressions as a source of knowledge, this study reflects on how metaphors can be used in therapeutic dialogue. We conclude that metaphors add to the understanding of descriptions of daily life in a more existential way, beyond the results gained from the grounded theory analysis. However, the findings from the analysis via grounded theory included aspects that we did not find when analysing the metaphors.

Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders

Recovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group.

A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 3. Changes in morbidity and clinical problems from admission to discharge

BackgroundCrisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the third paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the changes in morbidity and clinical problems from admission to discharge and the length of service.MethodsThe study was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, were the complete registration of patients of this team in the period from February 2008 to July 2009.ResultsThe findings indicate that the patients´ mental health status improved from admission to discharge, although many patients were discharged with the same mental health symptoms as those present at admission. However, one third of the patients were discharged with no clinically significant mental health problems. The majority of the patients of the CRHT team on the other hand seemed to be those with long-standing mental health problems, who were likely to be in need of continuing mental health care even after the resolution of mental health crises. There is a need for a coordinated system of community-based mental health services for patients with long-standing mental health problems, within which CRHT teams can play a pivotal role in making connections between the crisis-care and the recovery-oriented care. The mean length of service was around 15 days with variations by the clinical problem types, with the patients in the psychosis group having the shortest duration and the patients in the depression group having the longest duration.