https://doi.org/10.1177/1049732318756301 Qualitative Health Research 1–12 © The Author(s) 2018 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732318756301 journals.sagepub.com/home/qhr Research Article Background The patient-controlled admission (PCA) program is an organizational initiative launched in all regions of Denmark as a new option for selected patients with severe mental illness. Patients who are considered suitable for this new offer sign a contract with a mental health unit. The contract gives them the right to refer themselves to a brief PCA when needed, without going through the usual admission procedures in general practice or the emer- gency department. The intention is to engage psychiatric patients in self-management of their contact with their health care providers and enable them to seek timely help and thereby optimize their chances of recovery. Previously, studies about self-referral admission pro- grams have been reported from the United States (Nehls, 1994a, 1994b), Australia (Little & Stephens, 1999; Mortimer-Jones et al., 2016), Norway (Heskestad & Tytlandsvik, 2008; Moljord et al., 2016; Moljord et al., 2017; Rise et al., 2014; Sigrunarson, Moljord, Steinsbekk, Eriksen, & Morken, 2017; Tytlandsvik & Heskestad, 2009), the Netherlands (Helleman, Goossens, Kaasenbrood, & Achterberg, 2014; Koekkoek, van der Snoek, Oosterwijk, & van Meijel, 2010), Sweden (Strand, Bulik, von Hausswolff- Juhlin, & Gustafsson, 2017; Strand, Gustafsson, Bulik, & von Hausswolff-Juhlin, 2017), and Denmark (Ellegaard, Bliksted, Lomborg, & Mehlsen, 2017; Ellegaard, Mehlsen, Lomborg, & Bliksted, 2017; Thomsen et al., 2016). This indicates an international interest in new ways to organize mental health services and engage patients in self-management. The implementation of the Danish PCA program was a political decision based on promising results from Norway (Heskestad & Tytlandsvik, 2008; Tytlandsvik & Heskestad, 2009). The Danish PCA program was considered to be a supplement to regular hospital procedures, not a full substi- tute. In the Norwegian study, mental health professionals evaluated the PCA program positively and experienced it as 756301QHR XX X 10.1177/1049732318756301Qualitative Health ResearchEllegaard et al. research-article 2018 1 Aarhus University Hospital, Risskov, Denmark 2 Aarhus University Hospital, Aarhus, Denmark 3 Aarhus University, Aarhus, Denmark Corresponding Author: Trine Ellegaard, Psychosis Research Unit, Aarhus University Hospital, Skovagervej 2, DK-8240 Risskov, Denmark. Email: trinelle@rm.dk Integrating a Patient-Controlled Admission Program Into Mental Health Hospital Service: A Multicenter Grounded Theory Study Trine Ellegaard 1,2 , Vibeke Bliksted 1,3 , Mimi Mehlsen 3 , and Kirsten Lomborg 2,3 Abstract Patient-controlled admissions (PCAs) enable mental health patients by means of a contract to initiate an admission at a mental health hospital unit without using traditional admission procedures. This study was part of a 3-year Danish multicenter project, and we explored how mental health professionals experienced and managed the implementation of a PCA program. The methodology was grounded theory and the sample included 26 participants. We performed a constant comparative analysis to explore the concerns, attitudes, and strategies of mental health professionals. We developed a model of how the mental health professionals strived to integrate PCA into clinical practice. The process was motivated by the idea of establishing a partnership with patients and involved two interrelated strategies to manage (a) the patient-related duties and (b) the admission contracts. The professionals moved from a phase of professional discomfort to a phase of professional awareness, and ended up with professional comprehension. Keywords mental health nursing; psychiatry; professional; nurse–patient; theory development; qualitative; grounded theory; Denmark