Users’ involvement in mental health services: programme logic model of an innovative initiative in integrated care (original) (raw)
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BMC Health Services Research, 2019
Background: Mental illness is a leading cause of illness and disability and around 75% of people suffering mental illness do not have access to adequate care. In Australia, nearly half the population experiences mental illness at some point in their life. The Australian Government developed a National program called Partners in Recovery (PIR) to support those with severe and persistent mental illness. The program was implemented through 48 consortia across Australia. One of these was led by the Nepean Blue Mountains Medicare Local who adapted the program according to its specific local needs. Methods: We conducted an early evaluation of the PIR program in Nepean Blue Mountains (NBMPIR) using a program logic model (PLM) to frame the evaluation and complemented this with an additional thematic analysis. Participants (n = 73) included clients and carers, program management and staff of the Consortium and other partners and agencies, and clinical, allied health, and other service providers. Our PLM utilised multiple data sources that included document review, open and closed survey questions, and semi-structured interviews. Quantitative data received a descriptive analysis and qualitative data was analysed both in alignment with the PLM framework and inductively. Results: We aligned our results to PLM domains of inputs, activities, outputs, outcomes and impacts. The NBMPIR consortium implemented a recovery approach and provided greater access to services by enhancing healthcare provider partnerships. Our thematic analysis further described five key themes of collaboration; communication; functioning of PIR; structural/organisational challenges; and understanding of PIR approaches. Facilitators and barriers to the NBMPIR program centred on the alignment of vision and purpose; building an efficient system; getting the message out and sharing information; understanding roles and support and training of staff; building capacity and systems change; addressing service gaps; and engaging peers. Conclusions: Our study provided helpful insights into the coordinated management of complex mental illness. The NBMPIR's focus on partnerships and governance, service coordination, and systems change has relevance for others engaged in this work. This PLM effectively mapped the program, including its processes and resources, and is a useful framework providing a baseline for future evaluations.
Perceptions of health professionals on social inclusion in a Psychosocial Care Center
Revista da Rede de Enfermagem do Nordeste, 2019
Objective: to understand the perceptions of the technical team about social inclusion in the Psychosocial Care Center. Methods: qualitative research, developed with 20 health professionals. A semi-structured interview technique and non-participant observation were used. Data analyzed through the descending hierarchical classification and content thematic analysis, processed in the Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte software. Results: three categories emerged: Social inclusion, family participation in inclusion/ exclusion and income generation; Therapeutic activities: inclusion inside and outside the Psychosocial Care Center; and Challenges of inclusion: service management and professional training. Conclusion: prejudice or discrimination in this field, coupled with the difficulties of support of the management with service and stiffening of the work process with centrality in the psychiatric consultation, jeopardize attempts at rehabilitation and social inclusion of users and families. Descriptors: Social Support; Mental Health Services; Psychiatric Nursing; Mental Health. Objetivo: compreender as percepções de equipe técnica sobre inclusão social em um Centro de Atenção Psicossocial. Métodos: pesquisa qualitativa, desenvolvida com 20 profissionais de saúde. Utilizaram-se a técnica de entrevista semiestruturada e a observação não participante. Dados analisados por meio da classificação hierárquica descendente e análise temática de conteúdo, processados no software Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte. Resultados: emergiram-se três categorias: Inclusão social: participação familiar na inclusão/exclusão e a geração de renda; Atividades terapêuticas: inclusão "dentro e fora" do Centro de Atenção Psicossocial; e Desafios da inclusão: gestão do serviço e capacitação profissional. Conclusão: o preconceito ou a discriminação neste campo, aliado às dificuldades de apoio da gestão com serviço e "engessamento" do processo de trabalho com centralidade na consulta psiquiátrica, prejudica as tentativas de reabilitação e inclusão social de usuários e famílias.
International Journal of Health Policy and Management
Background: Individuals with serious mental illness face challenges in managing their health, leading to the need for integrating their needs and preferences in care decisions. One way to enhance collaboration between users and providers is to improve clinical governance; a shared responsibility between managers and providers, supported by healthcare organizations (HCOs), policies, and standards. We applied the concept of clinical governance to understand (1) how managers and providers can enhance the involvement of users in mental health, (2) the contextual and organizational factors that facilitate user involvement in care, and (3) the users’ perceptions of their involvement in care. Methods: We conducted two, in-depth case studies from two clinical teams in Canada offering outpatient care for users with acute mental illness. A total of 25 interviews were carried out with managers, and four focus groups were held with providers. A measure of patient-reported experience was used to...
Doing mental health care integration: a qualitative study of a new work role
International journal of mental health systems, 2015
Mental health care in Australia is fragmented and inaccessible for people experiencing severe and complex mental ill-health. Partners in Recovery is a Federal Government funded scheme that was designed to improve coordination of care and needs for this group. Support Facilitators are the core service delivery component of this scheme and have been employed to work with clients to coordinate their care needs and, through doing so, bring the system closer together. To understand how Partners in Recovery Support Facilitators establish themselves as a new role in the mental health system, their experiences of the role, the challenges that they face and what has enabled their work. In-depth qualitative interviews were carried out with 15 Support Facilitators and team leaders working in Partners in Recovery in two regions in Western Sydney (representing approximately 35 % of those working in these roles in the regions). Analysis of the interview data focused on the work that the Support F...
International Journal of Integrated Care, 2021
Introduction: Flexible Assertive Community Treatment (FACT) is a model of integrated care aiming to increase continuity of care for individuals with severe mental illness. FACT teams have been implemented in many countries by merging Assertive Community Treatment (ACT) and standard care from Community Mental Health teams (CMHTs). However, there has been little research on how practitioners experienced the fusion of these teams. Aim: This study explores how former ACT and CMHT practitioners perceived the implementation of FACT. Method: Perceptions of the FACT model, implementation strategies and adaptations of the model were investigated through 17 semi-structured interviews with FACT practitioners. Results: Perceived positive contributions of FACT included the recognition that FACT addressed a service gap for a group of patients who could benefit from increased support and improved integration of outpatient and hospital care. Perceived disadvantages of FACT included the experience that FACT drew away resources from ACT patients with the highest psychiatric needs. The findings also describe barriers to implementation, such as lack of perceived benefit of FACT, the maintenance of traditional work culture and insufficient organisational capacity. These challenges required the negotiation of local implementation strategies and adaptations. Conclusion: FACT increases access to intensive care for a broader group of patients with severe mental illness. However, findings from this study also suggest that the increased caseload in FACT compared with ACT and a changed mindset may not reflect the needs of the smaller group of patients who find it difficult to engage with mental health care services.
Journal of Clinical Nursing, 2004
Mental health: integrated network and family-oriented model for cooperation between mental health patients, adult mental health services and social services Background. Cooperation between mental health care units and the social services is important in the case of people with social problems who also suffer from mental health problems. However, participation of patients and their families in the treatment process, and cooperation between them and the professionals, are also important. Communication between the professionals, patients and their family members, and the professionals is a crucial factor for cooperation. Aims and objectives. The aim of this study was to elucidate the experiences and importance of cooperation for the patients. The data consisted of interviews with 22 mental health patients who were also clients of municipal social services. Method. The grounded theory approach was used, focusing on the informants' experiences of the integrated network and family-oriented model for cooperation. Results. The findings indicate the importance of the participation of patients and their social networks in psychiatric care or the treatment process. Meetings should be characterized by open and reflexive discussions with all participants' points of view being included, so that fruitful cooperation is possible. However, some negative experiences were also reported, all of which were connected with the professionals' behaviour. Conclusions. Trust and honesty are essential elements in relations between professionals and psychiatric patients, but it cannot be assumed that they will develop naturally. It is the professionals' responsibility to adjust their behaviour so that these elements can be created in a mutual process between patients and professionals. Multidisciplinary teams are a necessity in family-oriented cooperation between psychiatry and social services, and in a satisfactory caring process. Relevance to clinical practice. Nurses' work is often individually oriented and nurses are ruled by routines in their work. The mental health caring process should be seen as a shared process between the patient, his/her human environment and professionals for which nurses need skills to their interaction with patients and their social network.
Integrating Mental Health Services - Principles, practices and possibilities
Primary Care Medicine - Theory and Practice [Working Title]
The majority of mental health and addiction problems initially present to a primary care provider, with many being treated only in primary care. Problems in the relationships with mental health services, however, often mean that individuals needing care often do not reach the services they require, while primary care providers do not always receive the support or assistance they are looking for. Increasingly, though, mental health services are recognizing the importance of working more collaboratively with primary care colleagues and an effective way of achieving this is by integrating mental health services within primary care settings. This can improve access and the patient’s experience, and expand the kinds of mental health services that can be delivered within a primary care practice, with new opportunities for earlier detection, relapse prevention, support for self-management, and assistance with system navigation. It opens up novel opportunities for continuing education, impr...
2020
Background Various models for collaborative practice in mental health care incorporating the perspectives of service-user participation and collaboration in the care have been developed. However, the emphasis in these practice models has not been on identifying speci c features of "how" collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that speci es essential strategies operationalizing the tenets of service-user participation and collaboration applicable in mental health and substance abuse (MHSA) care. Methods A double helix approach of coalescing theoretical ideas and empirical ndings to develop a practice model that is applicable in MHSA practice. A theoretical analysis is carried out to identify the critical, foundational elements for collaborative practice in MHSA practice, and has identi ed the philosophical-theoretical orientations of Habermas' theory of communicative action, Bakhtin's dialogicality, and the philosophy of personhood as the foundational features of collaboration. This base is juxtaposed with the results of a qualitative meta-analysis of 18 empirical articles on collaboration in MHSA to advance a collaborative practice model speci cally in the domain of service user/professional collaboration. Results "The collaborative, dialogue-based clinical practice model" (CDCP Model) for community mental health care is proposed, within the structure of four main components. The rst speci es the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identi es the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identi es self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth speci es interactive-dialogic processes, negotiated-participatory engagement processes, and negotiated-supportive processes as the essential strategies of collaboration applicable in service user/professional collaboration which were extracted in the empirical work. An illustration of the CDCP Model in a clinical case is given. Conclusions The CDCP Model presented lls the gap that exists in the eld of community MHSA practice regarding how to operationalize systematically the tenets of person-centeredness, recovery-oriented, and pluralism-oriented practice in terms of user/professional collaboration.