Using qualitative methods, this study examined how, and under what circumstances, suicidal men used mental health services. In particular, the analyses focused on fragmented pathways to care. Fifteen men with a history of suicidal and aggressive behaviors and a diagnosis of borderline personality disorder and/or antisocial personality disorder participated in semistructured interviews that consisted of questions about their mental health status and experiences with mental health and addiction services. Interviews were taped and transcribed. An iterative, inductive qualitative analytic process was used. Men followed a cyclical pattern wherein negative experiences with health care providers were said to be followed by avoidance of health care settings, crisis, and then by involuntary service utilization. Men identified five health care provider and three personal practices, and two types of episodes they believed to contribute to their fragmented pathways to care. Implementation of specialized interventions, and providing patients with more information and more opportunity to participate in decisions, may improve interactions between patients and providers and improve patients' mental health status.
