CONTEXTUAL ANALYSIS OF FACILITATORS AND BARRIERS TO COMMUNITY-BASED MENTAL HEALTH SERVICE PROVISION FOR PATIENTS WITH SEVERE MENTAL ILLNESS AND SUBSTANCE USERS AT HIGH RISK OF VIOLENCE: A MULTI-LEVEL MIXED-METHODS STUDY

Abstract

Background: Patients with severe mental illness and substance use disorders, at high risk of violence (SMI-V), are a vulnerable population requiring appropriate mental health care. Community-based mental health services play a crucial role in preventing, managing, and reducing violence associated with this patient group. Objective: To explore the context and analyze facilitating and hindering factors of the services provision for SMI-V patients using a multi-level mixed-methods study. Methods: This mixed-methods research consisted of 1) quantitative analysis of secondary data from the HDC database of the Ministry of Public Health, and 2) qualitative structured survey through an online questionnaire with public health personnel in Loei Province. Data analysis employed descriptive statistics and content analysis.

Results: In the fiscal year 2023, there were 6,303 SMI-V patients (1.31%), with self-harm and harm to others being the most common behaviors. Qualitative analysis revealed facilitating factors such as family and community collaboration, strong working networks, and supportive policies, while hindering factors included negative attitudes, staff shortages, and insufficient budgets.

Conclusion: The findings highlight the challenges in providing the services for SMI-V patients. Developing an effective service system requires collaboration between agencies, capacity building of personnel, appropriate budget allocation, and raising awareness in the community.