Issues in Mental Health Nursing, 26:935–951, 2005 Copyright c  Taylor & Francis Inc. ISSN: 0161-2840 print / 1096-4673 online DOI: 10.1080/01612840500248221 ACUTE VERSUS PRIMARY CARE: THE HEALTH CARE DECISION MAKING PROCESS FOR INDIVIDUALS WITH SEVERE MENTAL ILLNESS Michelle DeCoux, RN, MS, CS University of California, San Francisco, School of Nursing, Department of Community Health Systems, San Francisco, California, USA Objectives: This study’s purpose was to determine factors influencing treatment choices of individuals with severe mental illness (SMI). The sample was drawn from admissions to residential crisis programs in San Francisco. Inclusion criteria were an Axis I and Axis III disorder. Methods: This qualitative study utilized grounded theory method. Interviews and field notes were coded for recurring themes. Descriptive data were also collected. Results: Participants revealed that the most important influences on treatment decisions were immediate need for care, the belief that their subacute complaints will not be taken seriously by providers, positive reinforcement for emergency service use, and enabling factors such as insurance coverage. Other remarkable findings included: numerous reports of substance induced medical crises, lack of support from family, and unawareness of client’s medical conditions in psychiatric facilities. Conclusions: Health care seeking behaviors are learned and learning that will promote the use of outpatient services in SMI must include positive experiences in the delivery of care in the primary care setting. Participants were knowledgeable regarding their I thank Dr. John Nickens of Progress Foundation, Dr. Susan Kools in the Department of Family Health Care Nursing at the University of California, San Francisco, and Dr. Linda Chafetz in the Department of Community Health Systems at the University of California, San Francisco for their contributions to the development and conduct of this study. Address correspondence to Michelle DeCoux, Samuel Merritt College, School of Nursing, 3100 Summit St., 3rd floor, Oakland, CA 94609. E-mail: michellehamp@yahoo.com 935 Issues Ment Health Nurs Downloaded from informahealthcare.com by University of California San Francisco on 10/08/14 For personal use only.