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Regional planning and the Implementation of Integrated Mental Health Care: the experience of Partners in Recovery

Author:

James Gillespie

Abstract

Title: Regional planning and the Implementation of Integrated Mental Health Care: the experience of Partners in Recovery

James A Gillespie

Introduction. Improved care integration is a core element for improvement of Australia’s mental health services. This requires fundamentally better links between health-focused care and social and community-based supports. The fragmentation of Australia’s health systems – ranging from a public hospital system funded and managed at state level and primary care at federal has created a series of fissures that have proved hard to bridge.  Policy-makers have supported an institutional shift to local and regional action to overcome these historic splits. This paper uses an institutional analysis of the Australian mental health system to identify some long-term elements shaping this continuity. It uses a recent innovative program, Partners in Recovery (PIR), to test the ability of a focused program break through these obstacles. From 2014-19 PIR combined a mental health recovery-based approach with an emphasis on building constructive partnerships between competing mental health providers.  PIR was one of the few initiatives in mental health that specifically aimed to bring together primary health care, mental health and non-health services. Its approach by-passed existing structures and used more flexible, locally based approaches aiming at system change.

Theory/methods.  Persistent failures to implement   reform, despite widespread consensus on the need for change suggests deeper, systematic problems. The paper uses public policy institutional theory to identify structural problems facing mental health service integration.

A narrative review of available evaluations of PIR programs across Australia assesses the degree action was based on knowledge of local services and problems. How far did each evaluated program identify bridging mechanisms across health and social policy and the mechanisms of ‘partnership’ between funding and delivery agencies in public and private (NFP) sectors? What information was used about local services to shape referral practices? What methods were used to gather information about the pattern of local services?

Evidence from Integrated Mental Health Maps produced for PIRs is used to show local differences in services and programs across PIRs.

Results. The evaluations had uneven information on the way individual PIRs tackled the problem of local knowledge and how they built referral networks.  Approaches ranged from systematic mapping of mental health services through to more ad hoc or passive methods.

Conclusions. The variation in methods make systematic comparisons difficult, but PIRs that started from a systematic approach to planning were less likely to have crises of overload or mismatches between client load and referrals. Lasting institutional changes were difficult due to the instability of the program and its final attempted integration into the very different National Disability Insurance Scheme.

Limitations: The research is based on publicly available evaluations and other papers on PIR. These include a national evaluation, but the local evaluations cover only a minority of PIRs.

Suggestions for future research: More work needs to be done on how new tools for mapping are used in policy and practice in developing regional and local approaches to service integration.

How to Cite: Gillespie J. Regional planning and the Implementation of Integrated Mental Health Care: the experience of Partners in Recovery. International Journal of Integrated Care. 2021;20(S1):158. DOI: http://doi.org/10.5334/ijic.s4158
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Published on 26 Feb 2021.

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