Perspectives on Coordinating Health Services for Individuals with Serious Mental Illness – A Qualitative Study

Figures & data

Table 1 Information About the Interview Participants (N = 27)

Variables		N
Gender	Female	22
	Male	5
Age (in years)	29–39	6
	40–49	15
	50–69	6
Municipality	Rural	13
	Urban	14
Education	Social educator	4
	Registered nurse	13
	Social worker	5
	Medical doctor	5
Employed in	Supported housing with round-the-clock healthcare	6
	Municipal inpatient acute care	2
	Mental healthcare institution	2
	Mental health home care	7
	Emergency room	4
	GP office	4
	Health and welfare office	2
Work experience in mental healthcare (in years)	1–10	8
	11–20	14
	21–44	5

Table 2 Interview Guide

Clarify responsibility areas

How is the cooperation between professionals in and between levels of care formalized?

Communication

How does communication occur between professionals or between professionals and service users? (for example, meetings, phone calls, oral, written, and electronic communication and information exchange) How is information adapted to each individual’s healthcare needs and capacity for involvement?

Facilitating transitions

How are transitions in and between levels of care facilitated?

Assessment of healthcare needs

How are the individuals’ healthcare needs mapped?

Monitoring care and response to change

How are the individuals’ health conditions and healthcare needs to be monitored and followed up? (for example, practices for referrals, care planning, treatment, and services) How do the Professionals prevent deterioration of health condition? How do the Professionals handle deterioration of health condition?

Align resources to the individual needs and linking appropriate services

How is the service provision tailored to the individuals’ healthcare needs and capability for involvement? How are the individuals involved in decision-making regarding services, treatment, care, and follow-up?

Self-management

How do professionals support service users with strategies for self-care and self-management?

Care plans

Do the individuals have a care plan? (for example, covering needs, goals, assigned services, and care coordination measures).

Table 3 Example of the Analysis Process

Preliminary Theme	Meaning Units	Code Group	Subgroups	Category
Proactive health services	Having a safe and stable place to live is fundamental to recovery and maintaining good health. We do not have a housing shortage in our municipality. We have vacant housing due to an excellent employee who is responsible for coordinating housing, which furthermore helps the individual to buy a home and enter the private market. We have resource-intensive individuals who have relocated from supported housing with round-he-clock healthcare and purchased their own homes later. Multidisciplinary meetings are vital, not only when things are severe, but also for creating plans and talking in peacetime to figure out what we can do for the individuals when their health deteriorates. The main issue is that numerous available healthcare services exist, but some individuals do not use them. It seems difficult for many individuals to receive care, especially when combined with drug use and alcohol dependency. Coordinating care and helping individuals to receive healthcare, including establishing contact with services, scheduling and helping prepare for appointments, and transporting to GPs, hospitals, emergency rooms, dentists, or other relevant services, are the most common work tasks for professionals in housing services.	Access to services and proactive care	Ensuring proper housing Access to services and assistance in receiving healthcare	Maintain a stable and meaningful home life