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

Introduction: Medication-Free treatment in mental healthcare aims to avoid pressure and coercion related to medication use, focusing on psychosocial interventions such as psychotherapy and milieu therapy. This approach emphasizes patient participation and voluntarism, aligning with human rights and shared decision-making principles. Knowledge about the challenges faced by mental healthcare professionals when introducing Medication-Free treatment in traditional mental health wards remains limited. This study aimed to explore the experiences of mental health professionals working in a ward that also offers Medication-Free services in order to gain a deeper understanding of this practice. Methods: A qualitative case study was conducted with two focus groups from a community mental health center ward in Eastern Norway. Data were analyzed using thematic analysis. Results: , was a common thread among the three themes: 1) Working within an inflexible structure: Mental health professionals experienced frustration due to rigid procedures that limited their ability to tailor treatments to individual patient needs. 2) The relationship between power and responsibility is not well balanced: Mental health professionals perceived a significant imbalance in power dynamics, with doctors and psychologists holding most of the authority. 3) Relational work with patients does not receive sufficient focus: Mental health professionals felt that the emphasis on relational work was inadequate, impacting the effectiveness of Medication-Free treatment. Conclusion: Medication-Free services conflict with traditional medical systems due to fundamental differences in philosophy, structure, power dynamics and focus. Systemic changes are necessary to create a more flexible, empowering and relationship-focused milieu that supports both approaches effectively.