Eva Brekke

• Johansen, Marthe; Ness, Ottar; Stuen, Hanne Kilen; Brekke, Eva & Landheim, Anne Signe (2026). 'They really want to find some kind of box they can put you in': How young people with severe mental health problems and complex needs talk about their past treatment in traditional Child and Adolescent Mental Health Services - A critical discourse analysis. Frontiers in Psychiatry. 17. doi: 10.3389/fpsyt.2026.1759231. Fulltekst i vitenarkiv Vis sammendrag

  Challenges in Child and Adolescent Mental Health Services (CAMHS), including complex and fragmented services, are well documented, particularly to young people with severe mental health problems and complex needs. Research on young people's experiences of CAMHS is scarce. Especially studies on young people who have dropped out of CAMHS and/or transitioned to alternative services are lacking. This article addresses the following research question: Which discourses can be identified when young people with severe mental health problems and complex needs enrolled in Youth Flexible Assertive Community Treatment (Youth Flexible ACT) articulate their past treatment in CAMHS, and contrast it with their current treatment? We conducted a qualitative study using semi-structured interviews with 12 participants aged 15 to 19, recruited via convenience sampling from three Youth Flexible ACT teams in Norway. The interview data were analysed using a Fairclough-inspired critical discourse analysis (CDA), where discourse is understood as a particular way of understanding and talking about the world, and language is seen as a social practice rather than an individual activity. We identified three dominant discourses when the young people talked about conventional services/CAMHS in Norway: a biomedical, a paternalistic and a neoliberal. The findings suggest that treatment in CAMHS is shaped by a market-oriented understanding of mental health (neoliberal discourse), a medical model that reduces complex problems to medical terms (biomedical discourse), and a lack of user participation (paternalistic discourse). The findings indicate a gap between what young people see as helpful, the aims outlined in guidelines and the young participants' descriptions of CAMHS. The lack of user involvement and the unequal power balance need to be actively addressed with concrete practices that support more equal participation. The findings highlight the need for more differentiated treatment pathways for this group of young people, enabling timely, tailored support and reducing the risk of ineffective initial interventions. Our findings indicate that the framework in CAMHS is poorly suited to the needs of this group. In contrast, differently organised services, such as Youth Flexible ACT, may offer an alternative by providing a coherent framework for holistic, integrated and person-centred care.

• Brekke, Eva (2025). Overdødelighet blant mennesker med rusmiddelproblemer: Mekanismer og løsninger på samfunnsnivå. I Olsvik, Bodil Severinsen; Sørly, Rita; Karlsson, Bengt Eirik & Ghaye, Tony (Red.), Nye perspektiver på menneskerettigheter, sosial ulikhet og sosial rettferdighet. Fagbokforlaget. ISSN 9788245045819. s. 149–167. doi: 10.55669/oa520107. Fulltekst i vitenarkiv
• Brekke, Eva; Lamu, Admassu Nadew; Angeles, Renira Corinne S; Clausen, Hanne Kristin & Landheim, Anne Signe (2025). Changes in inpatient mental health treatment and related costs before and after flexible assertive community treatment: a naturalistic observational cohort study. BMC Psychiatry. 25. doi: 10.1186/s12888-025-06614-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Flexible Assertive Community Treatment (FACT) is currently implemented in Norwegian mental health services, aiming to ensure comprehensive and rights-based services for persons with severe mental illness and complex needs, but also motivated by assumed cost-effectiveness. We need knowledge about the consequences of this service innovation. The aim of this study was to investigate changes in total and involuntary inpatient mental health treatment and associated changes in costs of inpatient days before and after enrolment into FACT for persons with severe mental illness and complex needs in Norway. Methods In this naturalistic observational cohort study of 397 patients in eight Norwegian FACT teams, we compared total and involuntary admissions, total and involuntary inpatient days, and the costs of total and involuntary inpatient days, for two periods: 24 months before and 24 months after enrolment in FACT. We used paired t-test. Results There was a significant reduction in involuntary admissions, involuntary inpatient days, and total inpatient days after enrolment in FACT. We found a slight but non-significant reduction in total admissions to inpatient mental health treatment. There was a significant reduction in the costs of total inpatient days and involuntary inpatient days. Conclusion Patients in FACT were admitted to inpatient treatment as frequently as before enrolment in FACT, but involuntary admissions were less frequent. Furthermore, the duration of involuntary and total inpatient treatment was reduced, with a corresponding reduction in costs as expected. Results suggest that targeted and well-timed interventions from FACT may reduce the need for prolonged involuntary inpatient treatment, implying reduced disadvantages for the individual and more efficient allocation of health service funding.

• Johansen, Marthe; Stuen, Hanne Kilen; Brekke, Eva; Jensen, Camilla Bergsve & Landheim, Anne Signe (2024). A qualitative study of the experiences of young people with severe mental health problems and complex needs regarding youth flexible assertive community treatment. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1478345. Fulltekst i vitenarkiv Vis sammendrag

  Youth Flexible Assertive Community Treatment (Youth Flexible ACT) is a service model for children and young people with severe mental health problems and complex needs aimed at providing integrated, continuous and holistic care. Studies on young people’s experiences of Youth Flexible ACT or similar models are scarce. The present qualitative study aimed to explore and describe how young people with severe mental health problems and complex needs experience follow-up and treatment provided by Youth Flexible ACT teams. Semi-structured interviews were conducted with 14 young people (age range, 15–19 years) who were being followed up by a Youth Flexible ACT team. Qualitative content analysis was used, and the following two overarching themes characterizing the young people’s experiences of follow-up and treatment provided by Youth Flexible ACT teams were identified: (1) trusting and collaborative relationships, and (2) organization matters. The participants experienced a more personal relationship with the staff, who behaved more like friends and paid attention to resources, interests, solutions and their context. The participants emphasized and valued components that coincided with the Youth Flexible ACT model, indicating a match between what the young people needed and wanted and what the model was supposed to provide. The team providing these relationships and youth-friendly and developmentally sensitive care appeared to be facilitated by how the service model was organized, with the teams being flexible and accessible while providing integrated, multifaceted help and systemic follow-up.

• Brekke, Eva; Clausen, Hanne Kristin; Brodahl, Morten & Landheim, Anne Signe (2023). Patients’ experiences with coercive mental health treatment in Flexible Assertive Community Treatment: a qualitative study. BMC Psychiatry. 23(1). doi: 10.1186/s12888-023-05264-z. Fulltekst i vitenarkiv Vis sammendrag

  Background: Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? Method: Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. Results: Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. Conclusion: Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.

• Brekke, Eva; Clausen, Hanne Kristin; Brodahl, Morten; Lexén, Annika; Keet, René & Mulder, Cornelis L. [Vis alle 7 forfattere av denne artikkelen] (2021). Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study. Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.727013. Fulltekst i vitenarkiv Vis sammendrag

  The aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.

• Brekke, Eva; Ness, Ottar & Lien, Lars (2020). Relational recovery in co-occurring conditions: a qualitative study of first-person experiences. Advances in Dual Diagnosis: Policy, practice and research in mental health and substance use. ISSN 1757-0972. 13(2), s. 89–100. doi: 10.1108/ADD-12-2019-0017. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: The purpose of this study was to explore and describe first-person experiences of relational recovery in co-occurring mental health and substance use conditions. Design/methodology/approach: Within a phenomenological and collaborative approach, indepth individual interviews with eight persons with co-occurring conditions were analysed using systematic text condensation. Findings: Participants described interpersonal relationships as both supporting and hindering recovery in fundamental ways. Four categories of experiences of relational recovery were described: (1) Choosing one’s child; (2) Living with loneliness and a painful past; (3) Sacrificing everything for one’s partner; and (4) Regaining trust and support. Originality/value: This article provides an enhanced understanding of how interpersonal relationships may be experienced by persons who live with co-occurring conditions. The results generally support an understanding of recovery as a relational process.

• Brekke, Eva; Lien, Lars; Nysveen, Kari & Biong, Stian (2018). Dilemmas in recovery-oriented practice to support people with co-occurring mental health and substance use disorders: A qualitative study of staff experiences in Norway. International Journal of Mental Health Systems. 12(30). doi: 10.1186/s13033-018-0211-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Recovery-oriented practice is recommended in services for people with co-occurring mental health and substance use disorders. Understanding practitioners’ perceptions of recovery-oriented services may be a key component of implementing recovery principles in day-to-day practice. This study explores and describes staff experiences with dilemmas in recovery-oriented practice to support people with co-occurring disorders. Methods Three focus group interviews were carried out over the course of 2 years with practitioners in a Norwegian community mental health and addictions team that was committed to developing recovery-oriented services. Thematic analysis was applied to yield descriptions of staff experiences with dilemmas in recovery-oriented practice. Results Three dilemmas were described: (1) balancing mastery and helplessness, (2) balancing directiveness and a non-judgmental attitude, and (3) balancing total abstinence and the acceptance of substance use. Conclusions Innovative approaches to practice development that address the inherent dilemmas in recovery-oriented practice to support people with co-occurring disorders are called for

• Brekke, Eva; Lien, Lars; Davidson, Larry & Biong, Stian (2017). First-person experiences of recovery in co-occurring mental health and substance use conditions. Advances in Dual Diagnosis: Policy, practice and research in mental health and substance use. ISSN 1757-0972. 10(1), s. 13–24. doi: 10.1108/ADD-07-2016-0015. Fulltekst i vitenarkiv Vis sammendrag

  Purpose The purpose of this paper is to explore and describe experiences of recovery among people with co-occurring mental health and substance use conditions (co-occurring conditions) in a rural community in Norway. Design/methodology/approach In-depth individual interviews with eight persons with co-occurring conditions were conducted, audiotaped, transcribed and analysed using a phenomenological approach. This study is part of a research project investigating recovery orientation of services in a Norwegian district. Findings The analysis yielded four dimensions of recovery: feeling useful and accepted; coming to love oneself; mastering life; and emerging as a person. Insecure and inadequate housing and limited solutions to financial problems were described as major obstacles to recovery. Research limitations/implications Further research into the facilitation of recovery as defined by persons with concurrent disorders is needed, particularly regarding the facilitation of community participation. Practical implications This study supports an increased focus on societal and community factors in promoting recovery for persons with co-occurring conditions, as well as service designs that allow for an integration of social services and health care, and for collaboration among services. Social implications The results suggest that the community can aid recovery by accepting persons with co-occurring conditions as fellow citizens and welcoming their contributions. Originality/value The paper provides an enhanced understanding of how persons with co-occurring conditions may experience recovery.

• Brekke, Eva; Lien, Lars & Biong, Stian (2017). Experiences of Professional Helping Relations by Persons with Co-occurring Mental Health and Substance Use Disorders. International Journal of Mental Health and Addiction. ISSN 1557-1874. 16(1), s. 53–65. doi: 10.1007/s11469-017-9780-9. Fulltekst i vitenarkiv Vis sammendrag

  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.

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• Skånland, Marie Strand; Solli, Hans Petter & Brekke, Eva (2025). Symposium: Music therapy in Flexible Assertive Community Treatment: What, how, and why? Fulltekst i vitenarkiv
• Landheim, Anne Signe; Brekke, Eva; Nord-Baade, Silje & Clausen, Hanne Kristin (2025). Supporting social inclusion and citizenship for people with serious mental health and substance use problems in Norway. Fulltekst i vitenarkiv
• Brekke, Eva (2022). Recovery-orientert praksis. I Lien, Lars & Lie, Tore Willy (Red.), Sammensatte problemer, sammenvevde tiltak: Integrert behandling av rus og psykiske lidelser. Fagbokforlaget. ISSN 9788245035599. s. 319–336. Fulltekst i vitenarkiv Vis sammendrag

  Samtidig rus og psykisk lidelse innebærer ofte et komplekst og mangefasettert tilstandsbilde, med mange potensielle problemområder. Ulike og ofte organisatorisk separate helse- og sosialtjenester er relevante i den sammenheng, periodevis eller langsiktig, hvor disse lidelsene må behandles samtidig på veien mot et bedre liv. Denne boken trekker veksler på forfattere med lang erfaring i ROP-feltet, både klinisk og akademisk, hvor blant annet følgende spørsmål belyses: Hvordan gi best mulig integrert og helhetlig behandling? Hvilke samhandlingsmodeller anbefales, og hvordan få til lokalt samarbeid mellom ulike tjenestenivåer? Hvilken basiskunnskap og kompetanse innen rus og psykiske lidelser burde alle ha uansett hvor de jobber? Hvordan kan du bistå i en annen persons bedringsprosess? Boken beskriver en rekke relevante fagområder for å få til et godt tjenestetilbud for personer med ROP-lidelser: Integrert behandling i praksis ACT og FACT Bolig og bo-oppfølging Vold og suicidalitet Kartlegging og utredning Rus og avhengighet IPS og arbeid Kriminalomsorgen og politi Oppfølging av somatisk (u)helse Fastlegens rolle Oppfølging og involvering av pårørende Brukermedvirkning Recovery-orienterte tjenester for personer med ROP-lidelser Boken er relevant i en rekke helse- og sosialfaglige utdanninger, og nyttig for alle som følger opp personer med rus og psykiske lidelser, uavhengig av profesjon, enten de jobber kommunalt, i spesialisthelsetjenesten, er fastlege eller jobber i somatikken.

• Brekke, Eva; Clausen, Hanne Kristin; Brodahl, Morten & Landheim, Anne Signe (2021). FLEXIBLE ASSERTIVE COMMUNITY TREATMENT AS A TOOL FOR SUPPORTING CITIZENSHIP. Fulltekst i vitenarkiv
• Brekke, Eva & Brodahl, Morten (2021). Recovery og personer med dobbeltdiagnose - dilemmaer og muligheder. I Hansen, Jeppe Oute & Jørgensen, Kim (Red.), Recovery-orienterede praksisser – i velfærdsinstitutioner og civilsamfund. Samfundslitteratur. ISSN 9788759335055. s. 127–144. Fulltekst i vitenarkiv
• Brekke, Eva; Lien, Lars; Davidson, Larry & Biong, Stian (2017). Recovery in Co-occurring Mental Health and Substance Use Disorders: First-person Perspectives. Fulltekst i vitenarkiv
• Brekke, Eva (2017). Strengthening recovery orientation of services for persons experiencing co-occurring mental health and substance use conditions. Fulltekst i vitenarkiv
• Brekke, Eva (2016). Recovery in co-occurrent substance use and mental health conditions – person-centred perspectives. Fulltekst i vitenarkiv
• Brekke, Eva; Lien, Lars; Biong, Stian & Davidson, Larry (2016). From double trouble to dual recovery: Patient perspectives on recovery in dual disorders. Fulltekst i vitenarkiv
• Brekke, Eva; Biong, Stian & Lien, Lars (2019). Recovery in co-occurring mental health and substance use disorders: A qualitative study of first-person and staff experiences. Universitetet i Sørøst-Norge/Universitetet i Søraust-Noreg. ISSN 9788278603857. Fulltekst i vitenarkiv Vis sammendrag

  People with co-occurring mental health and substance use disorders (COD) face challenges related to living conditions, community participation, and a lack of tailored and integrated health and social services. Recovery and person-centred approaches allow for an understanding of COD that is grounded in each individual person and his or her context, where lived experience is seen as a valued source of knowledge. There is a need for knowledge of how recovery and professional help are experienced by people with COD in different contexts. While recovery-oriented practice is recommended through national guidelines, there is little knowledge of how such practice works at the service delivery level. Knowledge is also needed on how practitioners experience recovery-oriented practice to support people with COD. This thesis has sought to contribute to the scientific knowledge on recovery and recovery-oriented practice in COD, with a particular focus on community services, by describing and exploring the lived experiences of people with COD and practitioners who work to support recovery in this group. An overarching purpose of the project was to make these lived experiences visible to decision makers in the field. The first aim was to explore and describe experiences of recovery among people with COD. The second aim was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by people with COD. The third aim was to explore and describe practitioners’ experiences with dilemmas in recovery-oriented practice to support people with COD. This project is influenced by phenomenological and collaborative methodology and consists of two qualitative studies. Study 1 consisted of eight individual, in-depth, interviews with people with COD, which were analysed with systematic text condensation. Study 2 consisted of three focus group interviews with practitioners in a municipal mental health and addictions team that was committed to developing recovery-oriented practice. The interviews in Study 2 were analysed using thematic analysis. Both studies were conducted in the same local authority area in Norway. An advisory group with people from the community with lived experience of COD, experience as family members, and professional experience has been involved in the project throughout. Results from this project support findings from other qualitative studies which indicate that control over symptoms may be a pathway to, but not the essence of, recovery. Systematic investigation of first-person experiences in this project has painted a broader picture of recovery in COD, which includes community participation, living conditions, and existential phenomena. Community participation, particularly feeling useful, may be a central facilitator in recovery. Adverse living conditions and loneliness may be important barriers to recovery in COD. There were individual differences in how participants related to substance use, but control over substance use seemed necessary in the process of coming to love oneself and emerging as a person. Professional helpers may play a central role in the recovery process once a trusting relationship has been established. Professional helpers’ ability to understand and act on people’s everyday struggles, and to address substance use in a competent and straightforward way, appear as specific valued attributes in professional helpers by people with COD. Practitioners described dilemmas in recovery-oriented practice to support people with co-occurring disorders; these involved how to relate to substance use in a recoveryoriented way, how to give enough help and still facilitate empowerment, and how to relate to people’s own life goals with neither moralism nor indifference. People with COD were described as expecting too little from services and tolerating unacceptable living conditions, which elicited directiveness from practitioners. This thesis concludes that a better life is possible for people with COD. While perceptions of a good life are similar to, and equally diverse as, perceptions in the general population, the degree of adverse living conditions and the amount of barriers in solving them seem particular to this group of citizens. In order for professional helpers to support recovery for people with COD, a trusting relationship is fundamental. Practitioners may experience dilemmas in recovery-oriented practice to support people with COD. Different traditions of understanding substance use may lead to different understandings of what it means to address substance use in a recovery-oriented way. Results from this thesis suggest that services to people with COD need to be flexible, integrated and allow for continuity. Professional helpers and services should be able to address living conditions and loneliness, and increase opportunities for genuine community participation for people with COD. Services should be able to address substance use in competent and individualised ways.

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