Utilization of Psychiatric Rehabilitation Services (Sal Shikum) among People Coping with Severe Mental Illnesses: The Contribution of Knowledge, Attitudes, Relationship with the Professional Mental Healthcare Provider, and Shared Decision-Making

People coping with severe mental illness (SMI) experience serious debilitation, decrease in quality of life and a significant decline in daily life functions. Sal Shikum (mental health rehabilitation basket) is an assortment of services provided to eligible persons coping with SMIs, with a 40% mental disability evaluation, in an attempt to reincorporate them into society. This act of reincorporation is designed to encourage rehabilitation and improve daily functions in all aspects of daily life. Studies have shown a positive correlation between utilizing Sal Shikum services and an increase in functioning and quality of life, alongside a decrease in the number of psychiatric hospitalizations. Nevertheless, only a portion of those eligible actually take advantage of the services available to them. Reasons for this underutilization of Sal Shikum services remain unclear due to a lack in relevant studies.

Hence, the current study examined factors contributing to the utilization of Sal Shikum services among those coping with SMIs, based on Andersen’s behavioral model of health service use  (Andersen, 1995). This model focuses on personal and system-related factors which explain seeking and utilizing healthcare services. This study focused on personal factors from the model, specifically examining the contribution of knowledge regarding Sal Shikum services, attitudes towards seeking professional mental health care, the relationship between the mental health care provider and the individual coping with SMI, and the degree of joint decision-making to utilization of Sal Shikum services.

The study population included 227 people coping with SMIs, who have been processed by the Sal Shikum committee. Data for this quantitative cross-sectional study was collected via questionnaires by approaching candidates through social media posts and distributing them to the relevant population who receive psychiatric support services at Barzilai hospital in Ashkelon. Data were analyzed using multivariate analysis.

Findings reveal that, as expected, those who utilized Sal Shikum services had more knowledge regarding Sal Shikum services, more positive attitudes towards seeking mental health care, a better relationship with their mental healthcare provider, and the level of joint decision-making was higher than among those who did not utilize Sal Shikum services. Nevertheless, in the regression model, only the nature of the relationship between those coping with SMIs and the mental healthcare provider and the individual’s attitudes towards seeking mental health care remained significant.

Moreover, as hypothesized, attitudes towards seeking mental health care partially mediated  the relationship between the nature of relationship between those coping with SMIs and their mental healthcare provider and utilization of Sal Shikum services. Conversely, the other mediating hypotheses that assumed that attitudes towards mental health care will mediate the relationship between level of knowledge regarding Sal Shikum services and utilization of Sal Shikin services, and between the level of joint decision-making and utilization of Sal Shikim services were not corroborated. Additionally, no differences were found in utilization of Sal Shikum services among participants from different backgrounds, according to various background variables.

These findings shed light on the profound significance of attitudes towards seeking mental health care and nature of the relationship between those coping with SMIs and their mental healthcare provider in explaining the probability of utilizing Sal Shikum services, in general, and as having a greater significance than level of knowledge regarding Sal Shikum services and level of joint decision-making.

On a theoretical level, the use of the Behavioral Model of Health Service Use in this study can contribute to the use of the model in new areas, such as in the use of “Sal Shikum” services. Also it can contribute to adding new significant variables when studying use of psychiatric rehabilitation services, such as the relationship with the mental healthcare provider

On a practical level, it seems important to develop programs for reducing barriers that lead to developing negative attitudes towards seeking mental health care, e.g., programs for reducing stigma towards mental health, which were found to contribute to positive attitudes towards seeking professional help. In addition, it is important to invest in programs for promoting positive relationships between people coping with SMIs and the mental health care providers that support them throughout the process of treatment and rehabilitation. It is important to invest in both the environmental and professional aspects: encouraging the addition of manpower to mental health treatment and rehabilitation services in order to increase availability and accessibility of service and reduce turnover, thereby contributing to a higher likelihood of an optimal therapeutic alliance; and by developing and implementing programs for the professional advancement of professionals in the field of mental health treatment and rehabilitation. Taking these actions can increase the number of individuals utilizing these services, which will eventually improve the quality of life, daily functions, and community involvement of those coping with SMI.