Lessons from the National Mental Health Integration Program

Article excerpt

Abstract

Three projects were funded under the national Mental Health Integration Program (MHIP) in 1999, each of which employed a different model aimed at improving linkages between disparate parts of the mental health system. A national evaluation framework guided local evaluations of these projects, and this paper presents a synthesis of the findings. For providers, the projects improved working relationships, created learning opportunities and increased referral and shared care opportunities. For consumers and carers, the projects resulted in a greater range of options and increased continuity of care. For the wider system, the projects achieved significant structural and cultural change. Cost-wise, there were no increases in expenditure, and even some reductions. Many of the lessons from the projects (and their evaluations) may be generalised to other mental health settings and beyond.

Aust Health Rev 2005: 29(1): 189-200

IN AUSTRALIA, MENTAL HEALTH CARE delivery involves a range of providers. These include public sector mental health services, funded by state or territory health departments, and private psychiatrists and general practitioners (GPs), funded federally. In addition, there are nongovernment organisations (NGOs) which may be funded from either source, depending on their remit.1 As with other areas of health, the differing sources of funding create duplication and gaps, opportunities for cost-shifting, and tensions between public and private sector services and providers.

In addition to differing in terms of funding sources, the public and private sectors dilfer in their approaches to treatment and support, and their service cultures. There are often difficulties in engaging private practitioners to provide services for consumers who are treated predominantly in the public sector, and, conversely, public sector services do not tend to give priority to consumers who are being seen in the private sector. Together, these factors result in a system that is fragmented and often difficult for consumers and carers to negotiate. Poor integration between services is not a new issue; solutions have been sought in other sectors and other countries.2 To date, however, none has been successfully applied to the Australian mental health sector. This paper describes an initiative known as the Mental Health Integration Program (MHIP), which explored approaches to improving linkages between disparate parts of the mental health system.

The policy context

In the last decade, major policy reforms in Australia's mental health sector have occurred under the National Mental Health Strategy. The Strategy has been operationalised in three National Mental Health Plans to date.3-5 The first plan, which covered the period from 1992 to 1997, was largely focused on reforms to the specialist public mental health sector (eg, increases in community-based care, decreases in stand-alone psychiatric hospitals, "mainstreaming" of acute beds into general hospitals). Under the second plan, which took the strategy forward from 1998 until 2003, far greater emphasis was given to the private mental health sector, and the complementary role it plays to the public sector. Fostering partnerships between the two sectors was a priority of the second plan and remains so in the new plan (2003-2008).

The Mental Health Integration Program

Among a range of initiatives aimed at improving the linkages between the public and private mental health sectors under the second plan, the (then) Commonwealth Department of Health and Aged Care (DHAC) provided MHIP funding for demonstration projects in 1999. The aim of these projects was to establish and document approaches to improving formal linkages between private psychiatrist services and public sector mental health services. Their overall purpose was to create a more flexible integrated framework within which mental health services can be delivered, to improve outcomes within available resources for the consumers of those services. …