Challenges in Implementing Evidence-Based Practice into Mental Health Services

By Deane, Frank P.; Crowe, Trevor P. et al. | Australian Health Review, August 2006 | Go to article overview

Challenges in Implementing Evidence-Based Practice into Mental Health Services


Deane, Frank P., Crowe, Trevor P., King, Robert, Kavanagh, David J., Oades, Lindsay G., Australian Health Review


Abstract

This paper highlights challenges in implementing mental health policy at a service delivery level. It describes an attempt to foster greater application of recovery-orientated principles and practices within mental health services. Notwithstanding a highly supportive policy environment, strong support from service administrators, and an enthusiastic staff response to training, application of the training and support tools was weaker than anticipated. This paper evaluates the dissemination trial against key elements to promote sustained adoption of innovations. Organisational and procedural changes are required before mental health policies are systematically implemented in practice.

Aust Health Rev 2006: 30(3): 305-309

IT IS NOTORIOUSLY DIFFICULT to ensure that appropriate innovations in mental health care are taken up and routinely implemented.1 Problems of diffusion are essentially the same as those found in organisations generally,2,3 including factory settings.4 For effective and sustainable dissemination, innovations need to:1,5,6

* Key into current organisational and individual staff objectives. Support from upper management and early adopters speed initiation; widespread support by middle management and staff increases effectiveness and sustainability.

* Be consistent with existing practices and easily applied. Time and competition with other work priorities are commonly cited barriers to uptake.

* Be communicated clearly and accurately, with implementers acquiring key skills and high self-efficacy for their implementation.

* Have appropriate resources for implementation, including structures for cueing, and checking and rewarding fidelity.

* Be accepted by consumers.

This paper relates a cautionary tale, in which an attempt to implement these principles has had only partial success.

Traditionally, mental health services have focused on symptom reduction and improved role functioning. However, the Australian National Mental Health Plan 2003-2008 (NHMP)7 adopts a primary principle that "A recovery orientation should drive service delivery". Anthony8 describes recovery as

... a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness.

Adoption of this goal and its routine application in mental health services may require some reorientation of objectives and practices.9

This case study examines the implementation of the Collaborative Recovery Training Program (CRTP), which provides training and support tools to assist mental health staff to implement recovery-based care with people affected by chronic mental illness, who have high levels of unmet need and require ongoing care. The objectives and strategy of the CRTP are congruent with the current NHMP7, a factor that contributed to partner organisation involvement.

Methodology/sequence of events

Details of the ethical, theoretical and empirical rationale for the Collaborative Recovery Model (CRM), the focus of the CRTP, were described elsewhere.10 Training of mental health workers was face-to-face over 2 days, followed by 6- and 12-month booster sessions. Sessions used manuals comprising:

* communication of guiding principles emphasising collaboration in clinical and support work, and nurturing of hope regarding recovery for people with chronic or recurring mental illness; and

* clinical skills training on facilitating motivation, assessing needs, establishing recovery goals, negotiating relevant tasks, designing and setting homework, and monitoring progress.

Workers were given related homework assignment and written support tools to help clients formulate goals.

Setting/participants

Participating organisations were public sector mental health services from four separate area health services and six non-government organisations providing support services for people with mental illness from four Australian states (South Australia, Victoria, New South Wales and Queensland). …

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