Background
Successful collaboration in mental health
Macro integration: systemic factors
Meso integration: organizational factors
Micro integration: clinical integration
Methods
Data collection
Mental health stakeholder focus groups consultations
State/Territory | No. of attendees | Organisational background |
---|---|---|
New South Wales | 6 | Carer and consumer groups NGO service providers |
Victoria | 8 | Carer and consumer groups NGO service providers |
Australian Capital Territory | 2 | Carer and consumer groups |
Northern Territory | 10 | Carer and consumer groups NGO service providers Territory mental health services |
South Australia | 6 | Carer and consumer groups NGO service providers |
Tasmania | 13 | Carer and consumer groups NGO service providers State mental health services Private practitioner |
Queensland | 6 | Carer and consumer groups NGO service providers State mental health services |
Western Australia | 7 | NGO service providers State mental health services |
Interviews with senior executives (including CEOs) and board members of Medicare Locals
State/Territory | No. of people interviewed | Role |
---|---|---|
New South Wales | 13 | 12 senior executives 1 Board member |
Victoria | 9 | 8 senior executives 1 Board member |
Australian Capital Territory | 1 | 1 Board member |
Northern Territory | 1 | 1 Board member |
South Australia | 9 | 9 senior executives |
Tasmania | 4 | 3 senior executives 1 Board member |
Queensland | 11 | 10 senior executives 1 Board member |
Western Australia | 3 | 3 senior executives |
Analysis
Ethics, consent and permission
Results
Barriers | Enablers | |
---|---|---|
Macro integration | Jurisdictional boundaries (intergovernmental and intersectoral) Sustainability and amount of funding Meeting funding requirements Service siloing | Dedicated funding |
Meso integration | Lack of agreement about the focus of care Failure to recognize the expertise of service providers | Knowledge of mental health Sharing of information Respect for service providers Local knowledge Population health planning identifying distribution and gaps in mental health services |
Micro integration | Centralisation of management once funding was obtained | Joint planning Designated PIR managers with program oversight Development of relationships between service managers Centralized intake Shared electronic records |
Macro integration: systemic factors
I think they need to look outside of the clinical sphere to get the solutions. …it takes a whole system so we work across housing providers, income training, skills development, legal, everything physical as well as mental health services (NSW focus group).
[The purpose of the] whole PIR program is not to work in silos. And it appears that they do. So there’s primary health and there’s mental health and then there’s LGBTI, you know, Aboriginal and Torres Strait Islander (Qld focus group).
There was never long term commitment though because they changed governments, and mostly you’ll get something for five years, and that’s if you’re lucky, and then a new government comes in and says, “Oh, no, we don’t need to spend money in that area.” That gets wiped (Tasmanian focus group).
….with the Partners in Recovery Program…they had NGOs providing the service but at the end of the day they were telling the NGOs what they could and couldn’t do and they were very descriptive [prescriptive] around what that looked like (NT focus group).
Meso integration
The Partners in Recovery people actually sit in the NGOs and then they connect people to the different services. So it breaks down those boundaries of patch protection and all those things, that consortium model and you’ve got to work out your differences and you’ve got to deal with whatever is happening (SA focus group).
….population and health planning were critical in that sense, giving us the data about where people were, specifically things like boarding houses…, the jails, the justice system, all those sorts of things where typically those clients would be, so the target areas were fairly well-defined for us (Senior Executive, Victoria).
I think we’ve all identified starting with the premise of respect, trust, a collaborative approach, a commitment to do what you say you’re going to do, a clear transparent process in working with the sector and working with a variety of sectors and variety of stakeholders (Qld focus group).
I think the model that [Medicare Local] put in place was very effective because what it then did also was invest in a whole range of different organisations. So they employed support facilitators and there’s innovation and collaboration grants (SA focus group).
….people with specific mental health skills and also an understanding of that particular geographical area where that particular PIRs been set up (WA senior executive).
Micro integration: clinical integration
Some of the PIRs are doing a great job and some of them are doing an absolute spin and are an absolute waste of money, because they have that whole space in between hasn’t been clearly described or actually collated (WA focus group).
….we’ve put a number of strategies in place that has improved things probably over the last 12 to 18 months and they include a centralised intake, electronic medical record. I’ve already talked about moving from a contractor model to an employee model and we have targets and KPIs for our counselling sessions.
…we have a general manager who might interact with some of those bodies and a health services general manager and then there’s a mental health manager who might interact with sort of the managers within those groups. So where it’s possible, we try to have up and down through the organisation, appropriate contact if you like because it gives us some kind of consistency in the relationship (Senior Executive, Queensland).
….we thought we were going to be a consortium for Partners in Recovery, however the Medicare Local then said - once they were awarded the funding for the tender they said ‘no, it was a consortium to get the tender’ (NT focus group).
They work with their local services to link people in so that our clinicians are aware of the services that are in their local regions and it might be employment services or we’ve got Partners In Recovery that we’re the lead agency for as well so they’re aware of them and they can refer to them (Senior Executive, NSW).
There has been nowhere to take information. The idea was that you work with a person and they will identify their needs and you’ll have a sense of perhaps what those barriers are for that person and also feedback from the community around what the barriers are, and you will feed that up, which we’ve been doing, but there is no one to hold that information (Qld focus group).