Paper short abstract:

Continuity of care (COC) is a high priority in mental healthcare. We explore this concept from the perspective of people living with severe mental illness. COC is often understood as absence of breaks or gaps in care, but we stress the need for embracing dis-continuity in Continuity of Care.

Paper long abstract:

This study addresses the increasing demand for Continuity of Care (COC) in mental healthcare. A need that is voiced by the political system, health care providers and care recipients as a response to fragmentation and specialization of health care. In mental healthcare, coordination of services and stability of patient-provider relationships is emphasized and COC is often defined in negative terms as the antipode to gaps, lags, inconsistencies, and interruptions in the delivery of healthcare.

In this study we explore diverse understandings of ‘relational continuity of care’ through the perspectives of the users of a community outreach treatment project for people with severe mental illness. Building on one year of interviews and observations of interactions between health care professionals and users, we explore how COC is an arena for the users to experiment with the situations in which they find themselves. For professionals, COC includes absence of breaks or gaps in care. Users, on the contrary, living with extraordinary conditions, experiment with agency during treatment by avoiding services because of extraordinary conditions. They find that breaks and gaps in care are a way to build and maintain self-control in a situation of despair, however they also worry about being excluded from the care program when avoiding services. We thus argue that conceptualization of COC should embrace dis-continuity in the notion of continuity.