Acute versus primary care: the health care decision making process for individuals with severe mental illness.
OBJECTIVE
This study's purpose was to determine factors influencing treatment choices of individuals with severe mental illness (SMI). The sample was drawn from admissions to residential crisis programs in San Francisco. Inclusion criteria were an Axis I and Axis III disorder.


METHODS
This qualitative study utilized grounded theory method. Interviews and field notes were coded for recurring themes. Descriptive data were also collected.


RESULTS
Participants revealed that the most important influences on treatment decisions were immediate need for care, the belief that their subacute complaints will not be taken seriously by providers, positive reinforcement for emergency service use, and enabling factors such as insurance coverage. Other remarkable findings included: numerous reports of substance induced medical crises, lack of support from family, and unawareness of client's medical conditions in psychiatric facilities.


CONCLUSIONS
Health care seeking behaviors are learned and learning that will promote the use of outpatient services in SMI must include positive experiences in the delivery of care in the primary care setting. Participants were knowledgeable regarding their illnesses and able to articulate symptoms of illness well. Failure to communicate symptoms appeared to reflect the participant's perception of a lack of response to their reports.
Decoux
Michelle
M
University of California, San Francisco, School of Nursing, Department of Community Health Systems, San Francisco, California, USA. michellehamp@yahoo.com
D000328:Adult; D003657:Decision Making; D004637:Emergency Services, Psychiatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology*; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012495:San Francisco; D012720:Severity of Illness Index