INTRODUCTION
1. Need for the Study
Globally, mental health policies and indicators aim to strengthen and expand community-based mental health services. Moving away from long-term hospitalization, there is an emphasis on transitioning to community-based services, necessitating the establishment of a phased service system that enables individuals with mental disorders to live outside of hospital settings [1]. The World Health Organization also emphasizes the need for sufficient community-based services to provide continuous care and welfare for patients [2].
To ensure sustainable community care services, it is essential to establish a system integrating not only mental health services but also housing, medical care, and rehabilitation services [2,3]. Community-integrated care projects, which involve multidisciplinary professionals collaborating to provide services, have already been implemented in various countries. These programs support the rehabilitation and social reintegration of individuals with mental disorders [4]. Studies have reported that such programs not only prevent rehospitalization [5] but also contribute positively to symptom management, improved social functioning, and enhanced quality of life [6-9].
In line with these global trends, South Korea has also pursued deinstitutionalization policies, making community integration for individuals with mental disorders a critical agenda [10]. A new care model is required to help individuals with mental disorders maintain an independent and autonomous life in the community, rather than rely-ing on a medical-centered service model. Successful community integration necessitates a comprehensive care model that integrates medical, housing, rehabilitation, and caregiving services [11]. Similar to existing approaches, this model should facilitate rehabilitation and prevent rehospitalization [8].
Despite its importance, the development of a community-integrated care model for individuals with mental disorders in Korea faces multiple challenges. Establishing an integrated community service system requires substantial national support. However, social stigma and prejudice toward mental illness persist, results in lower policy prioritization and inadequate mental health management strategies [12,13]. Additionally, mental health and welfare services remain segmented, highlighting the urgency for a national-level resolution [10,14].
Therefore, City A has piloted a community-integrated care project for individuals with mental disorders since 2019[14], marking a significant initiative. The project was implemented over a three-year period, from 2019 to 2021. Initially designed as a pilot project for the elderly, City A uniquely applied it to individuals with mental disorders, making it the only municipality in Korea to do so. This project targeted individuals with prolonged hospitalization or those lacking adequate community support. To support the recovery and independence of individuals with mental disorders post-discharge, the project established regional integrated care centers, expanded rehabilitation programs, created a housing support system and implemented a 24-hour crisis response system. Additionally, peer support specialists were trained, and cooperative associations were established to strengthen person-centered services and daily living support. Since its launch in 2019, the project has demonstrated positive outcomes in facilitating community reintegration and recovery opportunities [14].
While previous studies have examined the perspectives of service client regarding the effectiveness of the pilot project, research incorporating the direct experiences of professionals involved in the project remains limited. Given that the efficacy of community-integrated care services largely depends on the expertise of practitioners, it is crucial to investigate their experiences [15,16]. Exploring how these professionals perceive the effectiveness of the services provided, the challenges they encountered during implementation, and their insights on improving the integrated care system will offer valuable evidence for refining Korea's community-integrated care model. Understanding their experiences is essential not only for enhancing service delivery but also for ensuring the sustainability and long-term impact of integrated mental health care initiatives.
2. Purpose of the Study
This study aims to explore the experiences of professionals involved in the pilot community-care project for individuals with mental disorders. This project was designed to establish a standardized care model encompassing healthcare, housing, rehabilitation, and caregiving services. Through this exploration, the study seeks to provide empirical evidence necessary for developing a Koreanspecific standard model for community-integrated care for individuals with mental disorders.
METHODS
1. Research Design
This study is a qualitative descriptive study that uses focus group interviews to explore the experiences of practitioners participating in the Community Integrated Care for Individuals with Mental Illness project.
2. Study Participants
The study included 12 practitioners, consisting of 8 professionals working in mental health centers and 4 professionals working in public health centers. Among them, one was a registered nurse, three were public welfare officers (government social workers), and the remaining were social workers. All participants had at least six months of experience in the Community Care for Individuals with Mental Illness project. No specific exclusion criteria were set, and participants were informed that they could withdraw their consent at any time if they felt uncomfortable during the interview process. The general characteristics of the participants are presented in (Table 1).
3. Data Collection
The research leader directly contacted the relevant project institutions, explained the study's purpose and methodology, and provided details about the research process, including recording procedures and confidentiality assurance. Practitioners who met the selection criteria were verbally asked for their consent. Those who agreed were contacted individually via phone to reconfirm their willingness to participate, and final verbal consent was obtained.
Following the focus group research methodology [17], group size and the number of interviews were determined based on data saturation. This study explores the experiences of participants involved in the pilot project, and since the nature of their experiences may not be clearly structured, a group interview format was deemed more effective in facilitating mutual stimulation of perceptions. Therefore, the focus group interview method was employed to enhance interactive discussions and gain deeper insights into their shared and individual experiences [17]. Three focus group interview sessions were conducted, with group sizes ranging from 3 to 5 participants per session. Each group participated in one virtual interview session. Data collection took place from October 18 to October 22, 2021. The interviews were conducted in a semi-structured format based on pre-prepared questions.
Participants were selected from among those involved in the pilot project, rather than the entire participant pool. No participants withdrew or dropped out during the study. Field notes were taken during the interviews to document key observations and contextual factors that could support data analysis. Additionally, transcripts of the interviews were reviewed and confirmed by two participants to enhance the credibility of the data.
To ensure the quality and rigor of qualitative research, the research team made extensive efforts to minimize potential biases and enhance interview competency. Centered around the principal investigator, the team has consistently engaged in intensive interviewer training programs for over 10 years to refine their qualitative research skills. These efforts were aimed at facilitating in-depth exploration of the data and conducting interviews effectively, ensuring a robust and well-structured research process.
The interview process began with obtaining written consent, followed by an explanation of the study's objectives, the interview process, and recording procedures. The interview questions were developed based on a literature review and revised with feedback from two participants. The interview consisted of introductory, transition, key, and concluding questions. Introductory questions included, "What does Integrated Community Care mean in the context of community mental health?" Transition questions asked, "If you could summarize your experience in Community Care for Individuals with Mental Illness in one phrase, what would it be?" Key questions addressed aspects such as "the suitability of the project organization and model," "the appropriateness of participant criteria and discovery system," "the adequacy of the assessment and planning system for participants," "the current state of resources across four key domains: healthcare, housing, rehabilitation, and care," "collaboration and coordination," "positive outcomes and changes of the project," and "future directions and challenges." Each interview session lasted approximately 120~130 minutes.
4. Data Analysis
Data analysis followed the content analysis steps outlined by Downe-Wamboldt [18]. To ensure a thorough understanding, interview recordings and transcriptions were listened to and read at least three times. Initial thematic analysis identified seven thematic areas (communication, connection, integration, sustainability, change, growth, and needs). The research team and assistant researchers conducted the first coding using Atlas.ti 6.0 and Microsoft Excel. The initial coded data were refined through team discussions and validity verification.
Similar themes were grouped, reducing the original seven thematic areas to four main categories: communication and connection, integration and sustainability, change and progress, and need and challenge. The validity of these categories, subcategories, and initial codes was reviewed by three academic experts in community mental health and two relevant practitioners. Feedback from this review led to further refinement, including renaming one thematic area ("need and challenge") and modifying subcategory names. After a final review, four overarching categories, ten subcategories, and nineteen subthemes were identified. To ensure validity, two study participants and one expert in community mental health were consulted for the final verification of the analysis.
5. Ethical Considerations
This study adhered to ethical research principles, including informed consent, voluntary participation, confidentiality, and the right to withdraw at any stage. The research protocol was reviewed and approved by the appropriate institutional review board (IRB) (Approval No. 1044396-202108-HR-183-01). Participants were informed about the study objectives, data usage, and confidentiality measures before obtaining their consent. The recorded data were securely stored, and all identifying information was anonymized to protect participant privacy.
There were no conflicts of interest or prior relationships between the researchers and the participants. The research team maintained an objective stance throughout the study to ensure the integrity and neutrality of the findings.
RESULTS
The analysis of practitioners' experiences resulted in the identification of four main domains, ten categories, and nineteen subcategories. The four domains were "Integration and Maintenance," "Change and Advancement," "Communication and Connection," and "Need and Challenge." The "Integration and Maintenance" domain included "Comprehensive Support for Life." The "Change and Advancement" domain encompassed "Establishment of Core Care Systems," "Improvement in Service Quality," and "Increased Efficacy and Hope." The "Communication and Connection" domain comprised "The Importance of Organic Communication within the Integrated Care System" and "Increased Awareness and Interest." The "Need and Challenge" domain included "Improvement of the System to Reflect the Specific Needs of Individuals with Mental Disorders," "Enhancement of the Operational System," "Expansion of Resources," and "Establishment of a High-Quality Human Resource Infrastructure" (Table 2).
1. Integration and Maintenance
Within the domain of "Integration and Maintenance," the category "Comprehensive Support for Life" emerged.
1) Category 1: Comprehensive support for life
Practitioners reported that the pilot project enabled individuals with mental disorders to maintain stability within their community by ensuring continuity in life.
(1) Subcategory 1: Possibility of integrated care along the continuum of life
Practitioners confirmed that the pilot project aligned to maintain individuals with mental disorders within the community. They observed that previous services, which were fragmented and provided on a one-time basis, were now being delivered in a way that allowed for continuous and necessary support along the life continuum.
This project helps long-term hospitalized patients experience life outside of the hospital. The crisis response system, housing support, and rehabilitation programs are all crucial. Most importantly, the services are becoming systematized along the life continuum rather than being fragmented. (Participant 1)
The expansion of rehabilitation programs for members who struggle to utilize daytime services is highly meaningful. This means that rather than just providing housing support, we can now intervene in a more comprehensive manner by including household support and rehabilitation services. (Participant 11)
(2) Subcategory 2: Possibility of stable maintenance within the community
Practitioners recognized the importance of ensuring that individuals with severe mental disorders remain stably integrated within the community. They reported that tailored services for different types of service users-including hospitalized, crisis, and severe cases-were successfully implemented. These services served as crucial pathways to connect individuals with society.
Through this integrated care project, we established and provided customized services for different target groups such as those in crisis, long-term hospitalized individuals, and those with severe mental disorders. This enabled us to manage emerging issues within the community more effectively. (Participant 3)
For individuals to live in the community, they need opportunities for daytime community activities, referrals when necessary, and employment support. The integrated care system has allowed them to settle into such environments. Now, instead of the service center being the main actor, the system is designed so that individuals can take the lead in their own community lives with our support. This is a significant aspect of the project. (Participant 1)
2. Change and Advancement
Within the domain of "Change and Advancement," the categories "Establishment of Core Care Systems," "Improvement in Service Quality," and "Increased Efficacy and Hope" were identified.
1) Category 1: Establishment of core care systems
Practitioners confirmed that the pilot project successfully implemented and operated core service areas essential for the integration and maintenance of individuals with mental disorders, including healthcare, housing, rehabilitation, and caregiving.
(1) Subcategory 1: Establishment of core healthcare, housing, rehabilitation, and caregiving systems
Practitioners emphasized that the pilot project created a foundation for addressing previously underdeveloped areas, such as housing, rehabilitation, and caregiving, in addition to healthcare. The project enabled the development of cooperative partnerships within the healthcare system, strengthened housing support for individuals at various levels of need, and facilitated rehabilitation opportunities for long-term hospitalized patients who hesitate to discharge.
The pilot project allowed us to establish close relationships with local hospitals, which enabled us to respond effectively to crisis situations involving service users. (Participant 10)
Many individuals with mental disorders have difficulty accessing rehabilitation or housing facilities due to symptom severity, physical distance, functional limitations, and financial constraints. The pilot project significantly contributed to expanding rehabilitation opportunities and addressing these gaps. (Participant 9)
2) Category 2: Improvement in service quality
Practitioners noted a significant improvement in overall service quality, particularly in terms of transitioning from fragmented, one-time support to an integrated care approach and enhancing the quality of case management.
(1) Subcategory 1: Improvement in integrated support and case management
Practitioners reported that the pilot project increased opportunities for service user participation, strengthened workforce capacity, and enabled more effective case management for high-priority users. The integration of multi-disciplinary case conferences also facilitated a structured approach to incorporating expert perspectives into service planning.
With the implementation of the integrated care project, we started holding multi-disciplinary case conferences that included professionals such as child protection specialists and lawyers. This allowed us to develop more comprehensive care plans. (Participant 11)
With a reduced number of cases per practitioner, the quality of case management improved, strengthening the community safety net.(Participant 10)
3) Category 3: Increased efficacy and hope
Practitioners described experiencing a greater sense of efficacy in their work and observing increased hope and motivation among service users.
(1) Subcategory 1: Increased sense of professional efficacy
The transition from a provider-centered to a service user-centered care model allowed practitioners to offer more comprehensive and meaningful support, enhancing their confidence and professional satisfaction.
With external resources now available, case managers no longer have to handle everything alone. This has boosted their confidence and competence. (Participant 9)
The expansion of available services changed service users' perceptions of our center. Many individuals who had previously avoided contact are now actively engaging with us. (Participant 11)
(2) Subcategory 2: Increased hope and motivation among service users
Practitioners observed that service users who had previously exhibited low motivation began showing increased engagement in rehabilitation and reintegration into community life.
Service users are now thinking beyond simply receiving welfare benefits-they are exploring ways to change their lives for the better. (Participant 3)
The most significant impact of this project is the shift in service users' perceptions. As service quality improved, trust in our institution increased, which, in turn, enhanced their confidence in recovery and rehabilitation. (Participant 9)
3. Communication and Connection
Within the domain of "Communication and Connection," two categories emerged: "The Importance of Organic Communication within the Integrated Care System" and "Increased Awareness and Interest."
1) Category 1: The importance of organic communication within the integrated care system
Practitioners emphasized the task force's crucial role in guiding the objectives and direction of the mental health integrated care pilot project. They stressed the need for communication strategies and efforts to facilitate seamless collaboration between the healthcare and welfare services.
(1) Subcategory 1: Expectations for the task force as the key decision-making body
Practitioners had high expectations for the task force established to oversee the integrated care project for individuals with mental disorders. They anticipated that it would function as a clear control tower to drive motivation among practitioners and stakeholders, ensuring the project's sustainability and expansion. The task force was expected to serve as an integrated communication channel and a central hub for coordination.
Through the task force, the city has actively engaged in mental health initiatives, taking responsibility for decision-making and strategic planning. (Participant 1)
I believe the task force plays a vital role as a governing body, demonstrating accountability and providing enhanced administrative support. (Participant 2)
(2) Subcategory 2: Strengthening the connection between healthcare and welfare services
Practitioners acknowledged that, given the nature of mental disorders, the integrated care project was primarily driven by healthcare services. However, they also recognized the increasing role of welfare-related elements and emphasized the need for improved connectivity and communication between healthcare and welfare sectors.
The perspectives on mental disorders differ: healthcare views it in terms of diagnosis and treatment, while welfare focuses on recovery and rehabilitation. I wonder if these viewpoints were effectively integrated at the project's outset. (Participant 5)
As the role of mental health services in the welfare sector grows, we need to consider the limitations of both public health workforce capacity and welfare administration. (Participant 1)
2) Category 2: Increased awareness and interest
Practitioners observed that the implementation of the integrated care pilot project heightened community awareness of mental health services. This led to increased collaboration, improved perceptions of mental illness, and enhanced connections between the community and individuals with mental disorders.
(1) Subcategory 1: Improvement in public perceptions of mental disorders
Practitioners noted that the pilot project helped alleviate community concerns about individuals with mental disorders. Specifically, public exposure to peer supporters engaging in community activities contributed to greater understanding and reduced stigma. The project fostered the perception that mental health services could be integrated into the community rather than requiring isolation in institutional settings.
A community monitoring group, including local citizens, participated in the rehabilitation program. Observing peer supporters in action helped break down societal biases and misconceptions. (Participant 10)
Previously, there was a widespread belief that individuals with mental disorders needed long-term hospitalization and isolation from society. However, this project demonstrated that various institutions within the community could collaboratively provide care and support, leading to a positive shift in perceptions.( Participant 5)
(2) Subcategory 2: Increased community engagement and cooperation
Practitioners reported that the pilot project spurred increased interest and engagement in mental health and integrated care services among local government agencies and community stakeholders. This heightened awareness facilitated stronger cooperation and support for individuals with mental disorders.
The establishment of an integrated care center led to greater accountability among local governments. Notably, social welfare officials actively sought out and collaborated on public services, demonstrating a newfound commitment." (Participant 2)
During a recent case discussion forum, I noticed a significant rise in interest regarding the identification and support of individuals with mental disorders. Community discussions about care and referral systems reflected a growing awareness and dedication to this issue. (Participant 3)
4. Need and Challenge
The domain of need and challenge identified four key areas: "Enhancement of the program framework reflecting the specificity of persons with mental disorders," "Improvement of the program operation system," "Expansion of resources," and "Establishment of a high-quality human infrastructure."
1) Category 1: Enhancement of the program framework reflecting the specificity of persons with mental disorders
Practitioners emphasized the necessity of modifying and supplementing the program framework to reflect the unique characteristics of persons with mental disorders in the process of implementing the Integrated Care Program. Specifically, they identified the need for adjustments in the scope of roles of relevant institutions, the cooperative system, the evaluation framework, service eligibility criteria, and the care service system.
(1) Subcategory 1: Necessity for refining the scope of roles and cooperation among relevant institutions
Practitioners highlighted the importance of clarifying the role and limitations of integrated care service desks in the community, particularly as these desks play a crucial role in identifying new beneficiaries and increasing service engagement. They also stressed the importance of strengthening relationships with mental health welfare centers and public health centers to establish a solid community base.
Unlike elderly individuals, for persons with mental disorders, it is crucial to specify the roles and responsibilities of integrated care desks to enhance beneficiary identification and service engagement. (Participant 2)
Public health officials are subject to periodic job rotations. If roles and responsibilities in the identification and referral system for persons with mental disorders are clearly defined, the system will function effectively regardless of personnel changes. (Participant 5)
(2) Subcategory 2: Need for refining the evaluation framework
Practitioners emphasized the necessity of adopting a qualitative rather than a quantitative evaluation approach for the Integrated Care Program, given the chronic nature of mental disorders and the long-term nature of service provision.
Performance metrics cannot be ignored in our work, but since mental disorders typically require long-term care rather than case closure, qualitative evaluation is essential. The number of counseling sessions is important, but so is the presence of meaningful success cases. (Participant 5)
(3) Subcategory 3: Loosening and refining service eligibility criteria
Practitioners suggested that service eligibility criteria should be more segmented and refined to allow access based on life cycle stages and individual needs.
Since the pilot project was initially structured around elderly care, the distinction between shortterm and long-term care is crucial for them. However, for persons with mental disorders, short-term cases often transition into long-term cases, making this distinction less meaningful. (Participant 6)
The service eligibility criteria lack segmentation, limiting service provision tailored to life stages. Given the diversity of needs among beneficiaries, segmentation is necessary. (Participant 8)
(4) Subcategory 4: Establishing concrete care service standards and regulations
Practitioners acknowledged the positive aspect of private caregivers' inclusion in mental health integrated care services. However, they emphasized the need to establish care service regulations to define service scope, mitigate caregiver biases, and ensure sustainable service provision, including proper compensation.
Continuous discussions are necessary to determine the extent of household task support and criteria for service termination. (Participant 11)
The remuneration for household support workers must be set at realistic levels. Currently, they are working almost as volunteers. (Participant 8)
2) Category 2: Enhancement of the program operation system
Practitioners emphasized the need for two key aspects to ensure the systematic operation of the Integrated Care Program: the establishment of an information-sharing and referral system and the development of specific program guidelines and operational manuals.
(1) Subcategory 1: Establishment of an information sharing and referral system
Practitioners emphasized the importance of activating both online and offline data-sharing methods to enable collaborative management of identified cases among relevant institutions. They also stressed the need for a stable linkage system between community-based mental health welfare centers and other relevant organizations.
The most crucial aspect is establishing a discovery and feedback system among linked institutions. A structured referral system between mental health welfare centers and administrative bodies is necessary for effective program implementation. (Participant 6)
Meetings should focus on practical case intervention discussions. Frequent meetings among institution representatives to share information and define roles would be beneficial. (Participant 8)
(2) Subcategory 2: Need for program guidelines and operational manuals
Practitioners highlighted the necessity of comprehensive program guidelines to define the direction and objectives of the Integrated Care Program. Additionally, standardized operational manuals are needed to facilitate decision-making in service provision.
To enhance the understanding of the Integrated Care Program, guidelines addressing its direction and institutional aspects should be developed, along with practical manuals for practitioners. (Participant 9)
Service provision decisions are made through discussions among practitioners, related organizations, and center managers. A manual to verify the appropriateness of these decisions would be useful. (Participant 10)
3) Category 3: Expansion of resources
Practitioners underscored the importance of expanding service resources to meet beneficiary needs and ensuring systematic efforts, such as research and policy development, to stabilize resource expansion.
(1) Subcategory 1: Need for continuous resource expansion and institutionalization efforts
Practitioners noted that the pilot project enabled the operation of various housing and rehabilitation programs tailored to beneficiary needs. However, they stressed that housing remains a crucial and scarce resource, requiring further expansion.
Housing resources need to be expanded. Currently, public rental apartments are being used, but the process takes a long time. Many long-term hospitalized patients prioritize housing, yet resources are severely lacking. (Participant 7)
Despite an increase in mental rehabilitation facilities, group homes, independent living training homes, and supportive housing, waiting lists remain persistent due to the mismatch between demand and supply. (Participant 11)
4) Category 4: Establishment of a high-quality human resources infrastructure
Practitioners emphasized the importance of continuous efforts to train and retain specialized personnel for the Integrated Care Program. They also stressed the need for support measures to mitigate practitioner burnout.
(1) Subcategory 1: Need for strategies to train and strengthen the competency of professionals
Practitioners highlighted the necessity of an integrated, multidisciplinary service approach to address the complex issues of persons with mental disorders. They also stressed the need for structured training and support to enhance the expertise of community social welfare center personnel.
Without sufficient personnel, even the best services cannot be effectively provided. Maintaining a stable workforce is a critical issue. (Participant 10)
Community social welfare center staff often lack knowledge and experience in mental health. Practical, on-site training by mental health professionals is essential. (Participant 5)
(2) Subcategory 2: Support for practitioner burnout
Practitioners acknowledged that the expansion of the Integrated Care Program has increased their workload, making them more susceptible to burnout. They emphasized the need for improved working conditions, mechanisms for soliciting practitioner feedback, and continuous professional development opportunities.
Integrated care must be an ongoing initiative, yet practitioners operate in an environment prone to burnout. A practitioner support system is essential. (Participant 4)
As the Integrated Care Program expands, so does the workload for practitioners. Addressing practitioner burnout and collecting their feedback should be key priorities. (Participant 9)
DISCUSSION
Qualitative interviews with practitioners involved in the pilot project for community-based integrated care for people with mental disorders yielded the following findings:
First, community-based integrated care services were confirmed to be beneficial for maintaining continuous treatment and improving the quality of life of people with mental disorders. Practitioners recognized that the integrated care pilot project provided high-quality services, ensuring continuity and stability in the lives of people with mental disorders. Given the nature of mental illness, continuous service provision is essential, and timely intervention in crises significantly contributes to community integration. Housing services and crisis intervention services play particularly crucial roles in this regard. Stable housing support provides the foundation for individuals to sustain daily life and maintain social roles within the community [19]. Crisis intervention services ensure treatment continuity through timely responses to emergencies, thereby preventing rehospitalization [5]. The combination of these complementary services facilitates continuous community adaptation for people with mental disorders. This finding aligns with previous studies indicating that integrated care services positively impact quality of life and prevent rehospitalization [6-9,11]. Thus, efforts should be made to expand integrated care support functions and enhance the professionalism of various services.
Second, practitioners observed an increase in their sense of efficacy and professional development through participation in the community-based integrated care pilot project. The enhanced expertise of practitioners, resulting from increased efficacy, contributed to a virtuous cycle of service quality improvement. This effect was observed not only among mental health professionals but also among general social welfare professionals [20,21]. Given the pivotal role of professionals in delivering mental health integrated care services, sustained collaboration between healthcare and welfare sectors must be promoted. Furthermore, systematic efforts are needed to train and retain professional personnel and to establish support mechanisms to mitigate burnout [20].
Third, the pilot project underscored the importance of establishing a sustainable and systematic mental health care system. The interviewed practitioners emphasized that the central project management team should play a key role in facilitating communication and coordination among related institutions. Since multiple professionals are involved in service provision, clearly defining roles and ensuring ongoing communication are critical factors for the project's success [22,23]. Thus, a control tower should continuously promote cooperation, share information, and work toward systematization [24].
Based on these findings, the following tasks are proposed to enhance the integration of people with mental disorders into the community and establish a sustainable care system:
First, the integrated care support function should be expanded. The pilot project confirmed the necessity of medical, housing, rehabilitation, and care services for successful community integration and maintenance of people with mental disorders. To this end, stable service provision and sustainability must be ensured, and public-private partnerships must be strengthened. Housing support should focus on developing customized, needs-based programs and securing stable housing resources through public collaboration. Research should also be conducted to institutionalize housing support. Rehabilitation support should be expanded through the development of participatory programs tailored to beneficiaries, along with an increase in rehabilitation-related resources. Effective utilization and linkage of public and private resources within the community should also be pursued. In terms of care support, service scope and support systems for caregivers should be clearly defined, considering both the necessity and limitations of private resources, ensuring stable service operations. Healthcare support should reinforce existing collaboration systems and actively facilitate the transition of discharged patients into community life.
Second, the roles of project implementers should be strengthened, and public awareness should be raised. The pilot project confirmed that strengthening the workforce and establishing care service desks contributed to improved service quality, enhancing practitioners' confidence and motivation. However, the issue of practitioner burnout due to increased workload must be addressed, and systematic efforts are needed to train and retain high-quality professionals.
Third, the capacity for identifying community hubs and activating gateway functions should be enhanced. Administrative welfare centers play a crucial role as major hubs for identifying, referring, and linking people with mental disorders to services within the integrated care framework. To this end, the competencies and responsibilities of care service desk personnel should be clearly defined, along with their roles and limitations in integrated mental health care. Systematic training on mental disorders should be provided for care service desk personnel, and practical cooperation measures should be established. Additionally, an information-sharing system should be developed for service intervention partners, with both long-term and short-term plans for information exchange. A support system should also be implemented to promote active participation in interdisciplinary case conferences.
For these recommendations to be effectively implemented, stabilizing the operational structure of the project must be prioritized. Based on the achievements and areas for improvement identified in the pilot project, the following modifications to the program structure should be considered. First, the performance evaluation framework should be reexamined, transitioning from a quantitative to a qualitative assessment approach. Second, given the high demand for care services, a structured compensation system and training support for care workers should be established. Third, program guidelines and operational manuals specifically tailored to mental health integrated care should be developed. Fourth, service eligibility criteria should be expanded to allow for customized, life-cyclebased service provision. Fifth, systematic efforts should be made to continuously expand housing and rehabilitation resources.
Finally, efforts to improve public awareness and reduce the stigma surrounding mental disorders should be sustained. The ultimate goal of mental health integrated care is to achieve community integration and long-term sustainability for people with mental disorders. Community and resident cooperation are essential to this goal, and some progress in raising awareness and reducing stigma has been observed through the pilot project. Therefore, recovery stories and examples of successful community integration should be actively shared and promoted to garner community and resident support. This approach will effectively facilitate the integration of people with mental disorders into society.
However, despite the positive outcomes of the pilot project, several limitations should be considered for future implementations of integrated care. One major challenge was the constrained project timeline. Practitioners had to manage both their regular duties and additional responsibilities associated with the pilot project, which increased their workload and may have limited the depth of service implementation. To enhance effectiveness, future projects should allow for longer implementation periods, ensuring that practitioners can fully integrate new service models into their workflow.
CONCLUSION
Interviews with practitioners involved in the community-based integrated care pilot project confirmed that this initiative plays a vital role in maintaining continuous treatment and improving the quality of life for people with mental disorders. Practitioners' professional competencies were enhanced through service provision, creating a virtuous cycle leading to improved service quality. Furthermore, the importance of the project management team and collaboration among relevant institutions was emphasized, underscoring the need for a structured care system and sustained linkages. Consequently, key tasks such as expanding integrated care support functions, strengthening practitioner roles and public awareness, and activating community hub functions were identified. Additionally, stabilizing the operational system, refining the evaluation framework, securing sustainable resources, and improving societal awareness of mental disorders were highlighted as critical areas for future improvement. Through these efforts, people with mental disorders can achieve stable community integration and a sustainable care system, ultimately improving their quality of life and fostering social inclusion.
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