Paradoxes in Mental Healthcare: Exploring Service Gaps in Treatment and Care for Patients With Extensive Hospitalization Experience.

Patients with extensive hospitalization experience present challenges for mental healthcare by disrupting continuity of care across service systems. This study explores how mental healthcare services address the needs of these patients, focusing on service gaps between hospitalization and community services. By examining the underlying reasons for their reliance on hospitals, the study offers insights into the lived experiences of this marginalized group. The study aims to provide knowledge that can enhance treatment and care for patients with severe mental disorders. Using a narrative explanatory design, we interviewed 14 patients with extensive hospitalization experience. A holistic-content analysis revealed shortcomings in community services that contributed to frequent hospitalizations. These inconsistencies contributed to paternalistic treatment and collaboration issues, misaligning services with patients' needs. Patients were frequently labeled as "difficult" and placed at inappropriate levels of care, sometimes resorting to extreme measures to access the care they required. The study highlights paradoxes and contradictions between goals, policies, and service provision in mental healthcare. Patients were caught between two extremes entrenched in a struggle with services, either to gain access to support or to break free from service constraints. We argue that better access to institution-based treatment and care could provide benefits to these patients and help bridge service gap. Establishing long-term, well-staffed residential facilities would not only relieve hospitals of the burden of frequent readmissions but also enhance service integration. This would provide a much-needed middle ground, ensuring that patients receive the appropriate level of care while preventing unnecessary hospitalization.