Lars Henrik Ryther Myklebust

• Myklebust, Lars Henrik Ryther; Eide, Desiree; Arnevik, Espen Ajo; Dadras, Omid; De Pirro, Silvana & Ellefsen, Rune [Show all 14 contributors for this article] (2024). Evaluation of heroin-assisted treatment in Norway: protocol for a mixed methods study. BMC Health Services Research. ISSN 1472-6963. 24(1). doi: 10.1186/s12913-024-10767-w. Full text in Research Archive Show summary

  Background Opioid agonist treatment (OAT) for patients with opioid use disorder (OUD) has a convincing evidence base, although variable retention rates suggest that it may not be beneficial for all. One of the options to include more patients is the introduction of heroin-assisted treatment (HAT), which involves the prescribing of pharmaceutical heroin in a clinical supervised setting. Clinical trials suggest that HAT positively affects illicit drug use, criminal behavior, quality of life, and health. The results are less clear for longer-term outcomes such as mortality, level of function and social integration. This protocol describes a longitudinal evaluation of the introduction of HAT into the OAT services in Norway over a 5-year period. The main aim of the project is to study the individual, organizational and societal effects of implementing HAT in the specialized healthcare services for OUD. Methods The project adopts a multidisciplinary approach, where the primary cohort for analysis will consist of approximately 250 patients in Norway, observed during the period of 2022–2026. Cohorts for comparative analysis will include all HAT-patients in Denmark from 2010 to 2022 (N = 500) and all Norwegian patients in conventional OAT (N = 8300). Data comes from individual in-depth and semi-structured interviews, self-report questionnaires, clinical records, and national registries, collected at several time points throughout patients’ courses of treatment. Qualitative analyses will use a flexible inductive thematic approach. Quantitative analyses will employ a wide array of methods including bi-variate parametric and non-parametric tests, and various forms of multivariate modeling. Discussion The project’s primary strength lies in its comprehensive and longitudinal approach. It has the potential to reveal new insights on whether pharmaceutical heroin should be an integral part of integrated conventional OAT services to individually tailor treatments for patients with OUD. This could affect considerations about drug treatment even beyond HAT-specific topics, where an expanded understanding of why some do not succeed with conventional OAT will strengthen the knowledge base for drug treatment in general. Results will be disseminated to the scientific community, clinicians, and policy makers. Trial registration The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK), ref.nr.:195733.

• Lassemo, Eva & Myklebust, Lars Henrik Ryther (2021). Changes in patterns of coercion during a nine-year period in a Norwegian psychiatric service area. International Journal of Methods in Psychiatric Research. ISSN 1049-8931. 30(4). doi: 10.1002/mpr.1889. Full text in Research Archive Show summary

  Abstract Objective: There is debate regarding the use of coercion in the psychiatric services and how to minimize its use. We examine changes in the use of coercion in one Norwegian psychiatric service area during a nine-year period.Methods: All patients receiving psychiatric services during the periods 2003–2006 and 2008–2012 in the study area were identified, subsequently also only those who had been involuntarily admitted or subjected to involuntary outpatient treatment. Yearwise rates of patients admitted to coercion and coercive treatment-episodes throughout the study period were calculated.Results: The overall number and the rate of coerced patients decreased to the total patient population. Most of the reduction were initially of the observational period.However, the number of coercive episodes per coerced patient increased. The pattern of outpatient versus inpatient modes of coercion both reflected this main trend. Conclusion: The use of coercion seem to be reduced overall, although the increase in treatment-episodes per patient may indicate a complex pattern in use and registration of coercion. The results may be related to legislative changes,restructuring of psychiatric services, or/and modified attitudes of health-personnel to coercion following a range of efforts to reduce it.

• Lassemo, Eva ; Myklebust, Lars Henrik Ryther; Salazzari, Damiano & Kalseth, Jorid (2021). Psychiatric readmission rates in a multi-level mental health care system – a descriptive population cohort study. BMC Health Services Research. ISSN 1472-6963. 21(1), p. 1–15. doi: 10.1186/s12913-021-06391-7. Full text in Research Archive Show summary

  Background Readmission rates are frequently used as a quality indicator for health care, yet their validity for evaluating quality is unclear. Published research on variables affecting readmission to psychiatric hospitals have been inconsistent. The Norwegian specialist mental health care system is characterized by a multi-level structure; hospitals providing specialized -largely unplanned care and district psychiatric centers (DPCs) providing generalized -more often planned care. In certain service systems, readmission may be an integral part of individual patients’ treatment plan. The aim of the present study was to describe and examine the task division in a multi-level health care system. This we did through describing differences in patient population (age, sex, diagnosis, substance abuse comorbidity and length of stay) and admissions types (unplanned vs. planned) treated at different levels (hospital, DPC or both), and by examining whether readmission risk differ according to type and place of treatment of index-admission and travel-time to nearest hospital and DPC. Methods In this population-based cohort study using administrative data we included all individuals aged 18 and older who were discharged from psychiatric inpatient care with an ICD-10 diagnosis F2-F6 (“functional mental disorders”) in 2012. Selecting each individual’s first discharge during 2012 as index gave N = 16,185 for analyses following exclusions. Analysis of readmission risk were done using Kaplan-Maier failure curves. Results Overall, 15.1 and 47.7% of patients were readmitted within 30 and 365 days, respectively. Unplanned admission patients were more likely to be readmitted within 30 days than planned patients. Those transferred between hospital and DPC during index admission were more likely to be readmitted within 365 days, and to experience planned readmission. Patients with short travel time were more likely to have unplanned readmission, while patients with long travel time were more likely to have planned readmission. Conclusions DPCs and hospitals fill different purposes in the Norwegian health care system, which is reflected in different patient populations. Differences in short term readmission rates between hospitals and DPCs disappeared when type of admission (unplanned/planned) was considered. The results stress the importance of addressing differences in organisation and task distribution when comparing readmission rates between mental health systems. Keywords: Readmission, Psychiatry, Multi-level mental health care system, Survival analysis Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

• Myklebust, Lars Henrik Ryther & Lassemo, Eva (2020). The role of local inpatient psychiatric units and general practitioner on continuity of care in Northern Norway: A case-register study. International Journal of Methods in Psychiatric Research. ISSN 1049-8931. doi: 10.1002/mpr.1866. Full text in Research Archive Show summary

  Objectives: The general practitioners' (GP) role in the care of mental health patients has received increased attention. The literature underlines the need for integration of primary and specialist services, but cross-boundary continuity for patients with severe conditions may be particularly poor. The aim of this study was to analyze the collaboration between primary care and different models of specialized psychiatric services for patients with severe conditions. Methods: We compared a local and a centralized model of mental health care. Service utilization over a 5-year period was studied. Results: Findings suggest that a local institution-based model of services positively affects the use of both GP and specialist outpatient care, with most inpatients utilizing both GP and specialist outpatient consultations. In the centralized model, a substantial proportion of inpatients only used GP outpatient care. Furthermore, inpatients that used both GP and specialist outpatient services received more of both services compared to those who did not enter specialist outpatient care at all. Conclusion: Local inpatient units may positively affect continuity of care and collaboration between general practitioners and specialist psychiatric services compared to more traditional hospital units, probably because better functional integration of services, better facilitation of clinical alliances/relationships, or a more network-oriented treatment philosophy. Keywords: continuity of care; general practitioners; mental health; psychiatry.

• Myklebust, Lars Henrik Ryther; Sørgaard, Knut W. & Wynn, Rolf (2017). How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions. SAGE Open Medicine. ISSN 2050-3121. 5. doi: 10.1177/2050312117724311. Full text in Research Archive
• Myklebust, Lars Henrik Ryther; Sørgaard, Knut W. & Wynn, Rolf (2015). Local inpatient units may increase patients' utilization of outpatient services: A comparative cohort-study in Nordland County, Norway. Psychology Research and Behavior Management. ISSN 1179-1578. 8, p. 251–257. doi: 10.2147/PRBM.S94857. Full text in Research Archive
• Myklebust, Lars Henrik Ryther; Sørgaard, Knut & Wynn, Rolf (2014). Local psychiatric beds appear to decrease the use of involuntary admission: A case-registry study. BMC Health Services Research. ISSN 1472-6963. 14. doi: 10.1186/1472-6963-14-64. Full text in Research Archive
• Skre, Ingunn; Friborg, Oddgeir; Elgarøy, Sigmund; Evans, Chris; Myklebust, Lars Henrik Ryther & Lillevoll, Kjersti [Show all 8 contributors for this article] (2013). The factor structure and psychometric properties of the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) in Norwegian clinical and non-clinical samples. BMC Psychiatry. ISSN 1471-244X. 13. doi: 10.1186/1471-244X-13-99. Full text in Research Archive Show summary

  Background The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is a 34-item instrument developed to monitor clinically significant change in out-patients. The CORE-OM covers four domains: well-being, problems/symptoms, functioning and risk, and sums up in two total scores: the mean of All items, and the mean of All non-risk items. The aim of this study was to examine the psychometric properties of the Norwegian translation of the CORE-OM. Methods A clinical sample of 527 out-patients from North Norwegian specialist psychiatric services, and a non-clinical sample of 464 persons were obtained. The non-clinical sample was a convenience sample consisting of friends and family of health personnel, and of students of medicine and clinical psychology. Students also reported psychological stress. Exploratory factor analysis (EFA) was employed in half the clinical sample. Confirmatory (CFA) factor analyses modelling the theoretical sub-domains were performed in the remaining half of the clinical sample. Internal consistency, means, and gender and age differences were studied by comparing the clinical and non-clinical samples. Stability, effect of language (Norwegian versus English), and of psychological stress was studied in the sub-sample of students. Finally, cut-off scores were calculated, and distributions of scores were compared between clinical and non-clinical samples, and between students reporting stress or no stress. Results The results indicate that the CORE-OM both measures general (g) psychological distress and sub-domains, of which risk of harm separates most clearly from the g factor. Internal consistency, stability and cut-off scores compared well with the original English version. No, or only negligible, language effects were found. Gender differences were only found for the well-being domain in the non-clinical sample and for the risk domain in the clinical sample. Current patient status explained differences between clinical and non-clinical samples, also when gender and age were controlled for. Students reporting psychological distress during last week scored significantly higher than students reporting no stress. These results further validate the recommended cut-off point of 1 between clinical and non-clinical populations. Conclusions The CORE-OM in Norwegian has psychometric properties at the same level as the English original, and could be recommended for general clinical use. A cut-off point of 1 is recommended for both genders. Keywords: Outcome measure; CORE-OM; Translation; Reliability; Confirmatory factor analysis

• Myklebust, Lars Henrik Ryther; Sørgaard, Knut; Røtvold, Ketil & Wynn, Rolf (2012). Factors of importance to involuntary admission. Nordic Journal of Psychiatry. ISSN 0803-9488. 66(3), p. 178–182. doi: 10.3109/08039488.2011.611252.
• Myklebust, Lars Henrik Ryther; Olstad, Reidun E.; Bjorbekkmo, Svein; Eisemann, Martin ; Wynn, Rolf & Sørgaard, Knut (2012). Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway. International Journal of Integrated Care (IJIC). ISSN 1568-4156. 11. doi: 10.5334/ijic.674. Full text in Research Archive
• Myklebust, Lars Henrik Ryther; Sørgaard, Knut; Bjorbekkmo, Svein; Eisemann, Martin & Olstad, Reidun E. (2010). Time-trends in the utilization of decentralized mental health in Norway - a natural experiment: The VELO-project. International Journal of Mental Health Systems. ISSN 1752-4458. 4(5). doi: 10.1186/1752-4458-4-5. Full text in Research Archive
• Bjorbekkmo, Svein; Myklebust, Lars Henrik Ryther; Olstad, Reidun E.; Molvik, Stian; Nymann, Asle & Sørgaard, Knut (2009). Decentralization matters - Differently organized mental health services relationship to staff competence and treatment practice: the VELO study. International Journal of Mental Health Systems. ISSN 1752-4458. 3 (May)(9). doi: 10.1186/1752-4458-3-9. Full text in Research Archive
• Myklebust, Lars Henrik Ryther; SØrgaard, knut; Bjorbekkmo, S; Nymann, Asle; Molvik, S & Olstad, Reidun E. (2009). Bed utilization in two differently organized community mental health services in Northern Norway: the VELO-project. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 44(7), p. 550–557. doi: 10.1007/s00127-008-0470-6.
• Wynn, Rolf; Ryther Myklebust, Lars Henrik & Bratlid, Trond (2007). Psychologists and coercion: Decisions regarding involuntary psychiatric admission and treatment in a group of Norwegian psychologists. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039480701773139.
• Wynn, Rolf; Ryther Myklebust, Lars Henrik & Bratlid, Trond (2006). Attitudes to coercion among health-care workers and the general public in Norway. Journal of Psychiatric Intensive Care. ISSN 1742-6464. doi: 10.1017/S1742646406000252.
• Wynn, Rolf & Ryther Myklebust, Lars Henrik (2006). Patients' Satisfaction and Self-Rated Improvement Following Coercive Interventions. Psychiatry, Psychology and Law. ISSN 1321-8719. doi: 10.1375/pplt.13.2.199.
• Wynn, Rolf; Ryther Myklebust, Lars Henrik & Stensland, Geir Øyvind (2005). Attitudes to the use of diagnostic instruments among clinicians in northern Norway. Australian and New Zealand journal of psychiatry (Print). ISSN 0004-8674. doi: 10.1080/j.1440-1614.2005.01569.x.

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• Eide, Desiree; De Pirro, Silvana; Myklebust, Lars Henrik Ryther; Melis, Francesca; Oldervoll, Ann & Clausen, Thomas (2024). Norway's first heroin-assisted treatment clinics: initial impact of the intervention .
• Wynn, Rolf & Myklebust, Lars Henrik Ryther (2021). Adapting the traditional case report to a biopsychosocial format. European psychiatry. ISSN 0924-9338. 64, p. S745–S745.
• Wynn, Rolf & Ryther Myklebust, Lars Henrik (2017). Health professionals’ reactions to patients’ social media posts about treatment. International Journal of Integrated Care (IJIC). ISSN 1568-4156. doi: 10.5334/ijic.3262.
• Wynn, Rolf & Ryther Myklebust, Lars Henrik (2017). The decentralization and integration of Norwegian psychiatric services and possible implications for coercive practices. International Journal of Integrated Care (IJIC). ISSN 1568-4156. doi: 10.5334/ijic.3273.
• Ryther Myklebust, Lars Henrik & Wynn, Rolf (2017). The mortality gap. Patients with serious mental conditions. Mortality, morbidity and use of health services. European psychiatry. ISSN 0924-9338. doi: 10.1016/j.eurpsy.2017.01.565.
• Wynn, Rolf & Ryther Myklebust, Lars Henrik (2016). The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway. International Journal of Integrated Care (IJIC). ISSN 1568-4156. doi: 10.5334/ijic.2796.
• Ryther Myklebust, Lars Henrik & Wynn, Rolf (2016). Inpatients´ utilization of GP and psychiatric outpatient care. A comparison of a central-institution versus a local-institution based system of psychiatry. A case-register study. International Journal of Integrated Care (IJIC). ISSN 1568-4156. doi: 10.5334/ijic.2860.
• Ryther Myklebust, Lars Henrik; Sourouri, Saher & Olssøn, Ingrid (2011). The applicability of ‘Outcome Rating-Scale' and ‘Session Rating-Scale' in an outpatient hospital setting. Psychiatrische Praxis. ISSN 0303-4259. doi: 10.1055/s-0031-1277848.
• Lassemo, Eva Irene; Myklebust, Lars Henrik Ryther & Sørgaard, Knut W. (2011). Patient cost and treatment unit cost comparison in the VELO-Study. Psychiatrische Praxis. ISSN 0303-4259. 38. doi: 10.1055/s-0031-1277824.
• Myklebust, Lars Henrik Ryther & Wynn, Rolf (2009). Predictors of involuntary admission to a major Norwegian psychiatric hospital.
• Ryther Myklebust, Lars Henrik; Bjorbekkmo, Svein & Sørgaard, Knut (2009). Continuity of Care, Systems Integration and Patient Transitions: Central or Local Psychiatric Beds? The VELO-Project. European psychiatry. ISSN 0924-9338. doi: 10.1016/S0924-9338(09)71107-1.

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