Investigating the influence of contextual factors in the coordination of chronic mental illness care in a district health system

BACKGROUND: The global shift from institution-based to community-based care for chronic mental illness (CMI) care resulted in the de-institutionalization of clients with CMI. However, health systems which have been originally designed for acute hospital-based care do not seem to be appropriately transformed to manage CMI care at a community level. AIM: The aim of this study was to investigate how contextual factors influenced care coordination for chronic mental illness care within the eThekwini District. METHODS: This study employed a qualitative multiple case study design with instrumental approach. Maximum variation sampling was used to select five Community Health Centres (CHC's) and 48 health providers who worked with mentally ill clients in the sample CHC's. Framework analysis was used to analyze the results. RESULTS: Inequitably resourced catchment areas, unclear referral systems, high staff turnover, freezing of posts, chronic staff shortage and adverse working conditions contributed to care fragmentation, poor client care and client loss in the system. On the other hand, limited community support systems constituted barriers for client reintegration into society and relapses. CONCLUSION: The study concluded that the eThekwini District health facility settings were not adequately equipped to respond to care coordination demands for chronic mental illness care.