Moving On is Hard to Do: Barriers and Facilitators to Graduation from Intensive Community Mental Health Recovery Programming.

Intensive Community Mental Health Recovery (ICMHR) Services provide interdisciplinary mental health care in the community for veterans with serious mental illness. While initially recommended as time-unlimited, studies have shown that transition from such services to a lower level of care, termed "graduation," can occur safely and with sustained improvement. This study aimed to understand the perceived barriers and facilitators to the transition process from ICMHR services to lower levels of care. Semi-structured qualitative interviews were conducted with 15 ICMHR team members across the VA Connecticut Healthcare System. Data was analyzed using a rapid content and matrix analysis approach to generate consensus codes and themes. This study identified individual, programmatic, and systemic factors that influence veteran transition from ICMHR services to a lower level of care. Perceived barriers included: programmatic requirements, lack of comprehensive outpatient services, perception of ICMHR programs as time-unlimited, and clinician concerns around balancing caseload acuity. Perceived facilitators included: standardized tools for graduation readiness evaluation, positive team member attitudes towards graduation, early discussion of graduation, and team member advocacy for veteran graduation. Two factors were identified as both barriers and facilitators to graduation: strong team member-veteran relationship and balancing availability and quality of care. Despite acknowledgement of barriers, ICMHR team members expressed belief in and hope for veteran graduation with sustained improvement in function and quality of life. This study informs future research and quality improvement efforts aimed at facilitating individualized and recovery-oriented mental health care for individuals transitioning from intensive community-based to lower levels of care.