Abstract
The global shift from institution-based to community-based care for chronic mental illness (CMI) care resulted in the de-institutionalization of clients with CMI. However, health systems which have been originally designed for acute hospital-based care do not seem to be appropriately transformed to manage CMI care at a community level. The aim of this study was to investigate how contextual factors influenced care coordination for chronic mental illness care within the eThekwini District. This study employed a qualitative multiple case study design with instrumental approach. Maximum variation sampling was used to select five Community Health Centres (CHC's) and 48 health providers who worked with mentally ill clients in the sample CHC's. Framework analysis was used to analyze the results. Inequitably resourced catchment areas, unclear referral systems, high staff turnover, freezing of posts, chronic staff shortage and adverse working conditions contributed to care fragmentation, poor client care and client loss in the system. On the other hand, limited community support systems constituted barriers for client reintegration into society and relapses. The study concluded that the eThekwini District health facility settings were not adequately equipped to respond to care coordination demands for chronic mental illness care.
Highlights
The global policy shift from institution-based to community-based system of care for chronic illness culminated into the de-institutionalization of people with chronic illness, including individuals with chronic mental illness (CMI)[1]
Health facility settings Three sub-themes emerged from this theme namely, poor referral system and client cross-border migrations; poor health facility design and poor working conditions; and highworkload
This was characterized by health service user (HSU) cross-border migrations between catchment areas and the neighbouring Districts, consultation of more accessible traditional medicine (TM) practitioners or confusion about the referral system amongst the HSUs
Summary
The global policy shift from institution-based to community-based system of care for chronic illness culminated into the de-institutionalization of people with chronic illness, including individuals with chronic mental illness (CMI)[1]. The complexity of care coordination implies that poorly managed patient transitions between healthcare settings and between healthcare providers can result in care fragmentation and an increase in the risk of non-compliance to treatment and re-admissions to hospital. The global shift from institution-based to community-based care for chronic mental illness (CMI) care resulted in the de-institutionalization of clients with CMI. Health systems which have been originally designed for acute hospital-based care do not seem to be appropriately transformed to manage CMI care at a community level. Aim: The aim of this study was to investigate how contextual factors influenced care coordination for chronic mental illness care within the eThekwini District. Conclusion: The study concluded that the eThekwini District health facility settings were not adequately equipped to respond to care coordination demands for chronic mental illness care.
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