Bridging the gap between sectors in transition from mental health hospitals to communities - determining and mediating the need for assistance in daily living for patients with mental illness.

Background: Patients with mental illness often experience difficulties with participating in daily activities. Before discharge, it is therefore essential to assess patients' occupational performance to enable the municipalities to assign appropriate assistance. It is known that insufficient assistance in daily living may negatively affect health and well-being.

Aims: To explore which knowledge the municipalities need to assign appropriate assistance after discharge, the applicability of the knowledge delivered by the assessors and how they generated this knowledge.

Materials and methods: A qualitative interview study with 11 assessing occupational therapists and eight social workers.

Results: Most importantly was the type of occupations where the patients' needed assistance, and the type and amount of assistance. The knowledge delivered by the occupational therapists was in congruence with the municipal demands. However, generating the necessary knowledge was challenging, as the available evidence-based tools were not always found applicable.

Conclusions: The municipalities needed detailed descriptions of the patients' occupational performance to assign the appropriate assistance. The occupational therapists used both standardized and non-standardized assessment tools and faced difficulties in adhering to an evidence-based practice.

Significance: The findings underpin the municipal need for knowledge when assigning assistance and the need for evidence-based assessment tools for the occupational therapists working in mental health hospitals.