Exploring the Transition from Mental Health Halfway Houses to Community Living in Taiwan from the Perspectives of Ex-Residents, Families, and Staff

Background and Purpose:

In Taiwan, mental health halfway houses (MHHHs) are community-based facilities providing psychiatric rehabilitation services for people with mental illness to develop independence and enhance self-confidence. Ultimately MHHHs aim for their residents to be integrated into the community as independent living and community inclusion is a human right. Research on the transition from MHHHs to community living in Taiwan is scarce. Thus, in this study we aim to (a) explore the factors involved in the decision-making of this transition, (b) understand the experiences of the residents and their families with this transition, including the facilitating factors and obstacles that they had encountered, and (c) explore the practitioners’ practices related to this transition process.

Methods:

We collaborated with an MHHH in southern Taiwan for this research. Using purposive sampling we conducted semi-structured in-depth interviews with 10 ex-residents who have been discharged from the MHHH into the community for at least four months, 8 family members, and 11 MHHH practitioners for their viewpoints and experiences regarding this transition. We analyzed verbatim transcripts by following the conventional content analysis procedure proposed by Hsieh & Shannon (2005). After initial analysis we also conducted 2 focus groups for member check to enhance the rigor of this research.

Results:

Results showed that 5 ex-residents co-resided with their original family, 3 of them lived with their spouse or significant other, and 2 of them transitioned to an apartment-based residential program. The factors involved in the decision-making of this transition including ex-residents’ motivation and initiation, family needs and consent, affordability of community living, relative quality of life, peer connections, and encouragement from others. Most ex-residents expressed that they found freedom, autonomy, and being at ease in the experiences with community living. However, those who lived in a remote area or a low-income household experienced social isolation instead. Ex-residents identified self-motivation, independent living capabilities, and maintaining employment were essential facilitating factors in this transition while missing any of those facilitating factors and encountering discriminatory treatment due to mental illness stigma were obstacles in community living. Family members observed improvements in ex-patients, although some of them continued to provide support for their loved ones. Family members found that arranging day-time activities was the greatest challenge due to the lack of psychiatric rehabilitation resources and employment opportunities in the community. Additionally, family members appreciated substitute sources of care such as the apartment-based residential program. Finally, staff all agreed upon MHHH being a springboard for residents’ community integration. They considered resident motivation and family acceptance as the two most critical factors of successful discharges. Therefore, their work and practices were geared toward community living skill trainings and family engagement.

Conclusions and Implications:

Findings pointed to policy and practice recommendations including increasing community residential options, psychiatric rehabilitation programs, employment services, and activities for meaningful community participation. Developing family support programs is also crucial. Finally, MHHH policies should switch focus from emphasizing regulatory inspections to examining program capacity to execute family-involved, individualized discharge planning and service effectiveness regarding residents’ successful community integration.