Decision-making participation of people with mental health difficulties at a community rehabilitation center in Taiwan.

Purpose: This study employed institutional ethnography to analyse the experiences of individuals with mental health difficulties in a Taiwanese community rehabilitation centre.

Methods: This study applies the institutional ethnography method. Data were gathered through participatory observation; in-depth interviews with individuals with mental health difficulties and professionals; and textual analysis of policies, regulations, and practices within the centre.

Results: First, entrenched power dynamics persist, stifling discourse on the agency of individuals with mental health difficulties. The prevalent medical model continues to govern service provision, reinforcing professional hierarchies that impede collaboration. Second, community rehabilitation centres exacerbate disadvantages for case managers (who are muted in the presence of professionals) and service users (who lose autonomy in professional discussions). Third, compliance assessments overshadow individualized care. Fourth, the community rehabilitation model may inadvertently confine service users, prolonging institutionalization and conforming to societal norms.

Conclusions: This study underscores the need for significant improvements in Taiwan's mental healthcare system to emphasize individuals' rights.