Perspectives among mental health providers regarding rehospitalization of the chronically mentally ill

Abstract

Rehospitalization of persons diagnosed with chronic mental illnesses has been a problem since deinstitutionalization. While there has been little agreement among researchers, practitioners, families and consumers as to what is needed to improve this problem, it has been addressed frequently in mental health literature. The purpose of this qualitative 'grounded theory' field study was to explore perspectives of different levels of community mental health providers (i.e., directors, supervisors and direct service providers) (n = 15) from different community agencies regarding rehospitalization of persons diagnosed with chronic mental illnesses. Semi-structured interviews were conducted with each participant in three rounds of data collection. The data was coded and categories were collapsed into themes. As themes reached saturation, they were negotiated and refined into the working hypotheses. This method of constant comparative analysis allowed for negotiation of the final working hypotheses to develop 'grounded theory'. The results indicate there are differences and similarities among levels of community mental health providers regarding rehospitalization. Similar perspectives among participants included their view of needs for new and improved programs and increased education to decrease rehospitalizaton. Participants view multiple community mental health agencies as having strengths and limitations. Lack of perceived influence by persons in direct hierarchical line of authority was another commonalty. Differences were related to the scope of the providers' view, providers' perceived significance of impact on consumers, and level of openness regarding views and opinions. The results also reveal that different perspectives exist among agencies related to awareness of outside influences impact on their work with consumers. Implications of these findings include recommendations for both practice and research within this community mental health setting, as well as, to the social work profession. Recommendations for the setting in which the research was conducted include to further explore the findings of the study, specifically, the reported frustration regarding lack of team work among different agencies within the mental health system. Finally, social work research is encouraged to build knowledge and address problems from a social work perspective. It is recommended that further research be conducted from a social work perspective in the area of mental health.