Unlike in the U.S. and many other Western developed countries, policy makers and service providers in South Korea don’t see deinstitutionalization a taken-for-granted aim for people with severe mental illnesses (SMIs). In 2015 people with schizophrenia were hospitalized at psychiatric hospitals for 221.4 days on average, almost 32 times as long as in the U.S. Though little research is available, it appears that South Koreans with SMIs often have no choice except inpatient care due to the lack of or inadequacy of community-based mental health services (CBMHS). Further, research about continuity of care (COC) between hospitals and CBMHS and among CBMHS is largely absent. This qualitative study helps fill these gaps by asking South Koreans with schizophrenia living in communities about their experiences with discharge from psychiatric hospitals and with CBMHS, focusing on COC.
Twenty-one South Korean adults who identified as having schizophrenia and were living in the community participated in in-depth individual semi-structured interviews. Fifteen were men and 6 were women, with ages ranging from 26-71 (M=37.5). Participants were recruited through invitations distributed via a mental health advocacy group. Interviews addressed participants’ experiences in inpatient care and with CBMHS, emphasizing COC across different providers. Interviews lasted 45-90 minutes and were conducted in Korean. Using Atlas.ti 8, an iterative analysis of verbatim (Korean language) transcripts identified topic and in vivo codes, then themes were identified. Findings then were translated into English.
Four barriers associated with CBMHS undermined study participants’ successful reintegration into the community. First, participants reported that CBMHS did not attempt to coordinate services, instead offering only basic information. This lack of coordination led participants to say that CBMHS were ineffective in helping with psychiatric emergencies, early psychoses, medication adherence, and finding quality jobs. Second, Participants reported prolonged hospitalization, lack of psychosocial rehabilitation during hospitalization, and absence of discharge planning, which appeared to undermine their ability to live independently in the community. Third, participants were dissatisfied with their psychiatrists, who are the primary service providers in CBMHS. They reported discomfort with psychiatrists’ authoritarian attitudes and the majority said psychiatrists did not inform them of potential side effects of medications. Lastly, participants rarely heard about any evidence-based therapies and were unable to recall experiences with receiving psychotherapy.
Conclusions and Implications
Findings suggest that lacking many essential CBMHS and uncoordinated care from mental hospitals staff seem to inhibit deinstitutionalization of people with schizophrenia. To support successful reintegration of South Koreans with schizophrenia into their communities, psychiatric hospitals need to increase use of discharge planning, CBMHS need to actively pursue COC, and both venues need to consider whether they are implementing or connecting people to evidence-based interventions. In addition, psychiatrists need education about potential benefits of empowerment models that focus on developing partnerships rather than imposing their expertise. Further studies are needed to investigate the experiences of people with other SMIs, the perspectives of providers about COC, and provider-level factors associated with different levels of COC that people with SMIs experience.