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Table 1 Informant quotes

From: Self-admission to inpatient treatment in psychiatry: lessons on implementation

Start-up problems
 a Patient 10: I called once and the person who answered – I’m not sure if she was part of the regular staff at the ward – said something like: ‘No, I don’t know, you’ll have to call back later’. And that could easily have made me not call back at all, because I started hesitating.
 b Patient 9: I was given a date and time when I should come in, and then that same day I found out that they had offered that bed to somebody else. I felt really bad, having planned it and all – yes, it was really hard. […] I think they had forgotten that she was coming in that day. But then I was offered a bed the next day, so it was sorted out.
Problems associated with reserving a bed
 c Patient 1: It was so awkward, you were thinking about it every day: when is a good time, how do I know when to call? I don’t want to call every day to check if there’s a bed available because my illness doesn’t work that way.
 d Patient 2: Actually, once I’ve finally decided to self-admit, as of lately both beds have frequently been occupied.
 e Patient 13: You have to be flexible in case others are also asking for a bed. If I call now, although I really want to come in tomorrow morning so that I have time to pack and get ready mentally, they might say ‘Ok, but someone else called too so if you want the bed you’ll have to come tonight’.
Lack of staff continuity
 f Patient 11: You’re assigned someone for the day and usually you find out who that is at the morning meeting. Often they just say ‘Oh, you can come to any one of us’ and that’s too intangible for me. It would make me feel safer to know that this week, Anita is your contact nurse. She doesn’t work Wednesday and Thursday, but then Lisa is your contact. […] But I know that some patients like the fact that they don’t have a designated contact person – that it makes them feel freer, that they don’t get that hospital ward feeling.
Not enough emphasis on long-term goals
 g Patient 10: It’s just not possible to achieve that much in such a short amount of time. The contract is for brief admissions and changing a behavior takes time. It’s difficult to say how this could be improved.
Too demanding in terms of freedom and responsibility
 h Patient 1: This thing about deciding a lot for yourself - perhaps you need to be a little careful about that because if you get to decide for yourself, very often it’ll be the illness talking. So maybe there needs to be an open dialogue so that the staff is really responsive to what’s the illness and what’s favorable in order to move ahead.
 i Patient 2: If only I knew that I could handle it…I do think the freedom is a large part of what’s positive about this concept.
 j Patient 16: I asked for this opportuniy because I realized that it could be useful to have if things didn’t work out so well. But then when it’s time to make use of it - then it’s a whole different story. Then your will power needs to be even stronger.
Suggestions for alternative models
 k Patient 12: There are two beds. I’m thinking perhaps for one of them you could sort of sign up intermittently for the next 2 months, sort of ‘I wish to come in this week’.
 l Patient 3: I would like to know that these 2 days – or five days – every month are my days and I’m supposed to be at the ward.
 m Patient 3: I’ve been at the ward a whole week without actually sleeping there. So then I’m occupying a bed although I’m not really using it. That feels so wasteful – perhaps somebody else really needs the bed and I’m only there during the days. So I think there should be a slot solely for day treatment patients.