(De)-constructing continuity of care: the deinstitutionalization of support services for people with mental health...

The objective of this paper is to raise questions about appropriateness of the concept of continuity of care for guiding the development of helping strategies for people with mental health problems in the era of noninstitutionalization. Research on continuity of care is reviewed to show the strong legacy of institutional thinking. A leading problem addressed in this literature is that of client drop-out from programs designed to ensure continuity. The research results clearly suggest that this "problem" lies with the agency of clients: the fact that, in the natural milieu, they make decisions according to their own definitions of the situation and in a social context of their own. This perspective, however, seemingly cannot be incorporated into the continuity of care paradigm, which remains firmly grounded in the world of service providers. We argue, therefore, that the era of the noninstitutionalization calls for a recasting of the meaning of "continuity" for people with mental health problems, a reorientation of the type of research conducted in this domaine, and ultimately, a reformulation of the nature and role of support services in the community.