Why do mental health consumers who receive rehabilitation services, are not using them? A Qualitative Investigation of Users’ Perspectives in Israel

Abstract

A recovery-oriented approach to mental health involves creating person centered services and enhancing engagement in psychiatric rehabilitation. Israel's Rehabilitation in the Community of Persons with Mental Disabilities Law is a progressive initiative that shifted the locus of psychiatric care to community care supporting individualized rehabilitation and recovery-oriented processes. Yet over a quarter of applicants do not implement their assigned rehabilitation plans and services. This qualitative study investigated reasons and experiences related to lack of utilization from applicants' perspectives. Fifteen service users were interviewed face to face in semi-structured interviews analyzed using Grounded theory approach. Seven categories emerged: (1) Lack of knowledge and orientation; (2) Negative perceptions about rehabilitation services (3) Lack of active participation/shared decision-making; (4) Not feeling heard by the committee; (5) Lack of congruence between participants' goals and committee's final decisions; (6) Lack of escorting professionals' competencies; and (7) Family members' influence. The results are interpreted at the structural and human process levels. Suggestions are provided for augmenting systemic procedures and human interactions processes.

Consumers' understanding and expectations of a community-based recovery-oriented mental health rehabilitation unit: a pragmatic grounded theory analysis

“…In contrast, service providers emphasised limitations in consumer insight, stigma, language and cultural barriers. Similar findings emerged in a recent study completed in Israel exploring perspectives of people with severe mental illness who had rejected rehabilitation support (Moran et al 2016). Factors contributing to disengagement were negative attitudes and limited knowledge about rehabilitation, lack of involvement and incongruence between recommendations and their goals.…”

“…Most indicated active involvement in the decision to come to the CCU. These findings are important to note for future evaluation of outcomes for this service, particularly as other studies have offered lack of knowledge and negative attitudes towards rehabilitation as explanations for dis-engagement (Moran et al 2016).…”

Treatment engagement of individuals experiencing mental illness: review and update

“…Mental health services that integrate elements addressing an individual's immediate needs may enhance engagement. For example, housing and finances are two potential sources of significant stress that may impinge on someone's wellbeing.…”

Process and outcomes evaluation of a pre-academic arts program for individuals with mental health conditions: a mixed methods study protocol

“…The engagement of people with MHC in rehabilitation programmes remains a worldwide challenge84 85 partly because of difficulties involved in meeting the specific needs, goals and skills of each individual86 87 and providing personally meaningful services 88. Thus, to fill this gap, it is important to examine innovative rehabilitation programmes like the Garage that meet these components.…”