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Psychiatr Rehabil J. 2020 Jan 27. doi: 10.1037/prj0000404. [Epub ahead of print]

Coordination of services for people with serious mental illness and general medical conditions: Perspectives from rural northeastern United States.

Author information

1
Faculty of Health Sciences, Department of Public Health, University of Stavanger.
2
Geisel School of Medicine, Dartmouth College.
3
General Practice and Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland.
4
Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University.
5
Mongan Institute, Massachusetts General Hospital, Harvard Medical School.

Abstract

OBJECTIVE:

The objective of the study was to investigate providers' perspectives on how medical, mental health, and social services are coordinated for people with serious mental illnesses and general medical conditions in 2 predominantly rural states.

METHOD:

To achieve multiple perspectives on service coordination, this study includes perspectives from providers employed in community mental health centers, social service agencies, and primary care settings in 2 northern rural New England states with contrasting approaches to financing and organizing services. We conducted 29 individual semistructured interviews and 1 focus group, which included administrative leaders, team leaders, primary care providers, social workers, and case managers who provide services for people with serious mental illness. Data were analyzed using qualitative thematic content analysis.

RESULTS:

We identified key themes at 3 levels: (a) provider-level coordination: bridging across services; managing interprofessional communications; and contrasting perspectives on the locus of responsibility for coordination; (b) individual-level coordination: support for self-management and care navigation; trusting and continuous relationships; and the right to individual choice and autonomy; (c) system-level coordination: linking appropriate residential and care provision services, funding, recruiting and retaining staff, policy enablers, and integration solutions.

CONCLUSIONS:

Three levels of provider-reported coordination themes are described for the 2 states, reflecting efforts to coordinate and integrate service delivery across medical, mental health, and social services.

IMPLICATIONS:

Improvements in patient outcomes will need additional actions that target key social determinants of health. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

PMID:
31985242
DOI:
10.1037/prj0000404

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