"It's a catch-22 situation": Perspectives of male mental health service users with serious mental disorders on their community integration following a residential-based rehabilitation programme in South AfricaCann

Abstract

Introduction: Residential-based rehabilitation programmes were introduced to relieve the resource burden of long-term hospitalization in South Africa. More men of working age than women in South Africa require longitudinal support from public mental health services and the majority live in communities characterised by poverty and unemployment. There is limited research on male mental health service users' perspectives on the impact of residential-based rehabilitation programmes on their community integration. Method: An instrumental case study design was applied, and five male participants were identified through purposive sampling. Observations, semi-structured interviews, community maps and document analysis were used to collect data. Thematic cross-case analysis of qualitative data was done. Findings:  The theme, It's a catch-22 situation, describes the participants' ambivalence towards the residential-based rehabilitation programme contribution to their community reintegration after discharge. Three categories, namely 'It's not just what you call it', 'There's no one size for all', and 'It's tricky choosing between places to go and things to do', capture how the perceived inflexibility of the programme curtailed their adjustment to community living. Conclusion: Participants proposed co-constructing their recovery plan with mental health professionals so that it is more personalised in supporting them as they adapt to emergent occupational challenges. A seamless continuum of support between different levels of care should be implemented.