Abstrakt
Background
People with severe mental illnesses (SMI) often find themselves in a vulnerable position. They are more often, than the general population, exposed to for example, unemployment, homelessness and poverty (Greve, 2012). Furthermore recent research shows that, people with SMI are also exposed in relation to poor somatic health, as well as a lower survival rate, than the general population, within a wide range of illnesses (Crompton, et al., 2010; Lauersen, et al., 2007). Although people with SMI have a higher risk of physical illness, due to side effects of medications, unhealthy lifestyles, e.g. poor diet, smoking, alcohol- and substance use, there is a growing body of evidence that unequal access to and benefit from healthcare, also plays a role in this disparity (Lauersen, et al., 2007; Crompton, et al., 2010). It has been suggested that, not only do persons with SMI have less access to medical care; they are also less compliant with the medical care system (Crompton, et al., 2010; Lawrence & Kisely, 2010). A characteristic for a great deal of people with SMI is that they are experiencing considerable difficulty with self-care, particularly during periods when their mental illness is most severe. People with SMI therefore rely on the assistance in handling these matters; however people with SMI often have fragile social networks (Greve, 2012; Crompton, et al., 2010). Due to these difficulties a number of people with SMI permanently or temporarily live at municipal or regional housing services, that are offered on the basis of § 107 and 108 of the Danish Social Services Act (Socialstyrelsen, 2013). In other words persons with SMI represent a vulnerable group whose lives and health may depend on a well-coordinated multidisciplinary and cross-sectorial effort. Numerous studies on the other hand, indicate that there is a systemic separation of mental healthcare and physical healthcare and persons with mental illness therefore rarely receive the coordinated effort they require (Crompton, et al., 2010; Case Management Advisor, 2013; Lægeforeningen, 2011). The excess mortality of people with SMI may therefore also be due to organizational and structural problems in the health- and social services system.
The aim of the thesis
The interfaces between psychiatric treatment centres and the municipal social services centres, as well as between somatic hospital wards and somatic nursing homes, rehabilitation centres, etc. have gained much attention (Johansen, et al., 2012; Kistrup, et al., 2009). However the interface between the somatic hospital wards and community-based residential facilities appears more overlooked in the existing literature. This despite the fact, that the dynamics of this particular interface may be crucial for the coordination and quality of the service that people with SMI experience, when they require hospital admission due to somatic disorders. The present thesis therefore aims to explore the characteristics of the interorganizational interface between somatic hospital wards and community-based residential facilities for persons with mental illness, and to investigate whether there are any identifiable critical relations in the interface – in the thesis conceptualized as disorganization patterns – based on the views and experiences of the professionals working within the interface.
Method
The thesis is constructed as a qualitative research, based on four group- and six individual interviews with employees at a somatic hospital ward and two local community-based residential facilities for persons with mental illness. The empirical data is analysed through an interpretive approach, primarily based on a theoretical frame, consisting primarily of David L. Brown’s (1983) theory of interorganizational interfaces and conflicts and Janne Semann’s, Rasmus Antoft’s and Jeppe Gustafsson’s interorganizational theories and analysis model of disorganization patterns in interorgazational interfaces (Gustafsson & Seemann, 1988; Seemann, 1996; Seemann & Antoft, 2002).
Results
The study shows that, the interface in question can be characterised primarily as underorganized with an asymmetrical dependency, in which the residential facilities are more dependent on the hospitals than the reverse. Furthermore the analysis indicates that the residents' mental health problems cause the residents to fall outside the hospitals regular functional area, which leads to a void in the residential facilities task performance, concerning the health of residents. These interface conditions lead to the following identified disorganization patterns, consisting of disagreements about; when a hospitalized resident is ready for discharge from the hospital, whether the hospitals consider the residents as “real” patients or not, what kind of knowledge and approach that is the most crucial, in the care of the hospitalized residents and finally disagreements about whom is responsible for the missing flow of information and knowledge between the hospitals and the residential facilities.