Achieving Community Integration for Individuals with Serious Mental Illnesses in Mental Health Services: A Qualitative Study on Provider Perspectives of Service Activities

Background

Achieving community integration for individuals with serious mental illnesses is a key aim for mental health services. However, literature on how mental health providers perceive and implement community integration services is scarce. The primary focus of this study was to provide a framework that reflects the full spectrum of strategies included in public mental health services to facilitate community integration.

Methods

Using constructivist grounded theory, 18 semi-structured interviews with community mental health service providers and administrative staff were conducted and analyzed. Respondents were asked about the processes they used to implement community integration services. Interviews were transcribed verbatim and analyzed using principles of ground theory and ResearchTalks' "Think and Shift, Sort and Sift" approach, including quote identification, diagramming, memoing, creating individual participant episode profiles and monitoring of the data. These processes guided us to identify emergent categories and develop a framework to analyze provider activities related to community integration from the perspective of service providers and administrators.

Result

Broadly, providers interpreted community integration as establishing independent living for clients in their local communities through a discrete set of activities. Through analyzing our data, we created a three-component framework that reflected the types of activities conducted by providers: physical resources, life skills, and social connections. Providers that focused on physical resources emphasized locating and securing key resources for their clients in local communities, such as housing. Providers that focused on life skills emphasized on developing client abilities to conduct activities of daily living, navigate physical community settings, and fulfill occupational roles, such as employment or schooling. Within life skills, some providers discussed addressing client sense of safety in community settings, including training clients on how to handle social stigma and decrease their risks for violence victimization. Lastly, providers that focused on social connections focused on activities that fostered client relationships both within the mental health clinic and in their local communities. Across the three components in our framework, providers connected these activities to developing client capacities to live independently from mental health services in their community settings.

While some providers drew from across these three components, we identified a relationship between the components of services providers emphasized and providers’ role in services. Executive leadership emphasized the importance of self-efficacy, occupational activities, and graduation from services. In contrast, direct care providers were focused on the minutiae of safety, housing stability, stigma, and connections to community groups outside of mental health services.

Conclusions and Implications

While providers performed various activities to achieve community integration, their approaches were undergirded by the shared assumption that community integration involved functional independence from mental health services. Further, our framework revealed that activities were compartmentalized by providers and led to highly siloed understandings of community integration between providers. This suggests the need for more collaborative, team-based approaches which integrate the importance of client emotional security and social connections throughout community integration activities.