Dis-continuity in Continuity-of-Care: a pathway for more equal access to mental health care services?

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Abstract Background Access to healthcare is core to achieving universal health coverage. Reaching and obtaining appropriate health care services requires engagement by health care organizations and users. For people with mental illness, access emerges as a continuous process, reflecting oscillating health conditions. This challenges aspirations of continuity of care (COC), but we know little about the experiences of users. Methods We carried out observations of interactions between professionals and users (n = 18) and semi-structured interviews with users, professionals, and managers (n = 33) in the specialised mental health services in Central Denmark Region and FACT-inspired teams in three municipalities. We also conducted 3 focus groups with regional and municipal professionals from these teams. Data was analysed through a qualitative thematic analysis. Results From the perspective of users, COC builds on the acknowledgment of their entire life situation. For users, this is about making connections between their past, present and future lives. Past experience affect their present abilities to follow treatment and influence future hopes and expectations. The acknowledgment of these connections often translates into spaces of discontinuity in continuity, where users need occasional breaks from treatment but worry about being excluded from treatment. Crucially, the organization of the FACT-inspired teams allows for flexibility in the intensity of visits and treatment. The norms of professionals also support users’ perspectives on COC, as the norms focus on building trust in the relations between users and professionals. Conclusions One important step to achieve more equal access is to integrate the social world of users. This requires organizational and professional approaches that allow for user needs for dis-continuity in COC. Key messages • For mental health service users, continuity-of-care includes breaks from treatment (discontinuity). • More equal health access requires adapting continuity-of-care to needs as perceived by users.