title: Why do mental health consumers who receive rehabilitation services, are not using them? A Qualitative Investigation of Users' Perspectives in Israel.
abstract: A recovery-oriented approach to mental health involves creating person centered services and enhancing engagement in psychiatric rehabilitation. Israel's Rehabilitation in the Community of Persons with Mental Disabilities Law is a progressive initiative that shifted the locus of psychiatric care to community care supporting individualized rehabilitation and recovery-oriented processes. Yet over a quarter of applicants do not implement their assigned rehabilitation plans and services. This qualitative study investigated reasons and experiences related to lack of utilization from applicants' perspectives. Fifteen service users were interviewed face to face in semi-structured interviews analyzed using Grounded theory approach. Seven categories emerged: (1) Lack of knowledge and orientation; (2) Negative perceptions about rehabilitation services (3) Lack of active participation/shared decision-making; (4) Not feeling heard by the committee; (5) Lack of congruence between participants' goals and committee's final decisions; (6) Lack of escorting professionals' competencies; and (7) Family members' influence. The results are interpreted at the structural and human process levels. Suggestions are provided for augmenting systemic procedures and human interactions processes.
authors.affiliation: Department of Community Mental Health, University of Haifa, Mount Carmel, Haifa, Israel. galiam@bgu.ac.il.|The Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel. galiam@bgu.ac.il.
authors.forename: Galia S
authors.initials: GS
authors.lastname: Moran
authors.affiliation: Department of Community Mental Health, University of Haifa, Mount Carmel, Haifa, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Baruch
authors.affiliation: Department of Social work, University of Haifa, Haifa, Israel.
authors.forename: Faissal
authors.initials: F
authors.lastname: Azaiza
authors.affiliation: Department of Community Mental Health, University of Haifa, Mount Carmel, Haifa, Israel. mlachman@univ.haifa.ac.il.
authors.forename: Max
authors.initials: M
authors.lastname: Lachman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000534:rehabilitation; D008605:Mental Health Services; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D036301:Qualitative Research; D055815:Young Adult
keywords: Individually tailored rehabilitation services; Recovery oriented care; System change; User participation