Towards a model for collaborative practice in community mental health care (original) (raw)
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Community-based Shared Mental Health Care: A Model of Collaboration
Shared mental health care is being developed as a community-based model of service delivery that is described as a collaborative model with the intention to shift cultures of general practice from simple referral models to stronger models of collaboration. This article examines the degree to which community-based shared mental health care can be considered a collaborative model of care, and the implications for policy and practice and for consumers recovering from depression and related disorders. Victorian-based research informs the discussion, together with literature that discusses shared mental health care. Overall, the literature supports the view that there are positive outcomes of shared primary mental health care, including continuity of care for consumers and enhanced skills for general practitioners. However, features of collaborations such as inter-disciplinary trust, working together, shared planning or sharing of resources are weak in shared mental health care, suggesting that current practice models are working at a level of cooperation rather than true collaboration. The conceptualising of shared mental health care practices in terms of the theory of par partnerships and collaborations can only inform and strengthen the foundations of shared mental health care.
How is the collaborative-practice competency operationalized by mental health workers
International Journal of Rehabilitation Research, 2006
The recovery-focused competencies currently endorsed in policy emphasize collaborative relationships between mental health workers, service users, families and communities. Based on a qualitative research methodology, multi-disciplined practitioners shared their perceptions as to how mental health workers could operationalize collaborative relationships. Two community mental health centres were the setting for three focus groups, where 16 voluntary participants contributed to focused discussions. Participants discussed the pragmatics of how they work collaboratively; identifying knowledge and attitudes that underpin their practice, and elaborating on environmental influences that impact on a collaborative approach. Findings from the study recommend the practitioner role as one of advocacy and facilitation. The collaborative approach, which is inextricably related to the quality of the practitioner-service user relationship, aids sense-making for service users of their mental health experience. This requires of practitioners the qualities of openness, expression of hope, genuineness and people-first attitude that supports the building of knowledge rather than communicating it.
Collaborative care models for integrating mental health and primary care
University of Western Ontario Medical Journal
Background: Mental health service demands in Ontario often result in long wait times and a lack of access to specialized services. As a result, primary care providers are frequently required to provide mental health care for patients with complex diagnoses despite a lack of support or sufficient training. To address these issues, a shift toward collaborative models of mental health care delivery is occurring. Objective: This paper aims to assess whether evidence-based policy recommendations to improve collaborative mental health care are addressed in the recent Patients First documents. Methods: To achieve this, a qualitative analysis was conducted using NVivo10©. Results: While many of the evidence-based policy recommendations were mirrored in the Patients First documents, very few addressed collaborative mental health care directly. Implications: More research is required to fully understand the effects of the implementation of Patients First on mental health systems and services.
BMC Health Services Research, 2020
Background Health policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment. Methods We conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the inter...
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 specific features of “how” collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies 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 findings 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 identified the philosophical-theoretical orientations of Habermas’ theory of communicative action, Bakhtin’s dialogi...
International Journal of Mental Health Systems, 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 specific features of "how" collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies 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 findings 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 identified 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 specifically 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 first specifies the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identifies the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identifies self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth specifies 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.
Three months in the life of a community mental health team
Psychiatric Bulletin, 1994
An audit was undertaken to assess the efficacy and efficiency of a community-based mental health service which attempts to prioritise the care of those with severe and enduring disorders. Referral patterns over a three month period and change in case-load over the subsequent 12 months were recorded. Seventy-five per cent of new referrals met the priority group criteria, allaying anxieties that community services unceasingly get drawn to the care of those with less severe disorders. Furthermore, at 12 months the service had maintained contact with all patients previously admitted to hospital and all those presenting with psychotic disorders (27% referrals). Some changes in service structure are also suggested as a result of this evaluation.
The British Journal of …, 1993
Over the last two decades the movement of mental health care from the hospital base to community settings has involved great changes in the organisation and use of services. This has led to a need for evaluation of new services in order to guide future planning. We report here preliminary results from a study evaluatinga new multidisciplinary team which has close links with primary care. The development of the new service Rowland eta! (1989), in a response to the Gnffiths report, Community Care: an Agenda for Action, emphasised the central position of a multidisciplinary team in assessing patients' needs and delivering care. Community-based multidisciplinary teams have become increasingly widespread in Britain as models for the delivery of the new services based in community mental health centres, and there are plans for further expansion (Kingdon, 1989).Studies of such services report an improvement in the accessibility of services and in satisfaction of clients and general practitioners (Onyett et a!, 1990). However, there have also been reports of difficulties in establishing priorities in the work of the teams, resulting in the relative neglect of patients with severe and chronic mental illness (Patmore & Weaver, 1990a; Sayce et a!, 1991). An alternative to the development of community mental health centres is the extension of specialist mental health services into primary care. Different models of collaboration between psychiatrists or other mental health professionals and general practitioners have been described (Strathdee & Williams, 1984; Mitchell, 1985) and the effects of such attachments reported (Tyrer eta!, 1984; Brown eta!, 1988). There are, however, few reports of the effect of a multidisciplinary team working in close collaboration with primary-care services. We set out, therefore, to develop such a service and to examine its effects on the care available to patients and the patterns of service use which resulted. Community mental health team Initiallythe team comprisedthree full-time members: two community psychiatric nurses and one social worker. These were joined by a full-time occupational therapist after ten months and a clinical psychologist five months later. The team is supported by medical input on a sessional basis: three senior registrars and two consultant psychiatrists provide six sessions between them. The psychology input was also sessional in the first year until the arrival of the full-time psychologist. Administrative support is provided by a part-time secretary. The team has an office and two interview rooms at a community health centre shared by health visitors, school nurses and other community health services. Patients are generally seen at this clinic, at their own homes or in the general practitioners' surgeries, but occasional use is made of other community facilities, such as a social-services day centre. Members of the team work closely with 11 general practitioners working in three practices. The services 102, 504â€"506. WEIS5ROD, B. A., TEST, M. A. & STEIN, L. I. (1980) Alternative to mental hospital treatment (2) Economic benefit-cost analysis.