Service engagement and serious mental illness: The obstacles and barriers to attendance in a post-treatment recovery outpatient setting

This qualitative study examined the factors that affect treatment adherence and service engagement in individuals with serious mental illnesses (SMI). A semi-structured interview was used to collect data from treatment adherent and treatment non-adherent adults with SMI. What factors make one more or less likely to disengage from treatment? What boundaries stand in the way of quality mental health care, and how do adults with SMI overcome these barriers? Service engagement in the SMI population in the study was explained according to three healthcare behavior models, the Health Belief Model, the Network Episode Model, and the Demoralization Framework Model. Data collected from the narratives of twelve participants suggest that provider factors, including treatment style, theoretical orientation, and communication style can be protective factors against systemic barriers. In light of the results of narrative data, health behavior models that emphasize process-oriented behaviors in consideration with a broader social structure are better predictors of healthcare engagement than rational, value-expectancy models.