Coordination of Care in Australian Mental Health Policy

By Banfield, Michelle A.; Gardner, Karen L. et al. | Australian Health Review, May 2012 | Go to article overview

Coordination of Care in Australian Mental Health Policy


Banfield, Michelle A., Gardner, Karen L., Yen, Laurann E., McRae, Ian S., Gillespie, James A., Wells, Robert W., Australian Health Review


Introduction

The latest Australian health reform documents on the National Health and Hospitals Network1,2 and Medicare Locals3 placed a strong emphasis on coordination and integration in the health system, including in mental health. Changes to fundholding arrangements and the way in which mental health services are managed, particularly in primary care, were the subject of specific attention in these reports. The 2011-12 Budget also committed $1.5 billion over 5 years for improving the mental health system, including packages for addressing coordination of care and improving primary mental healthcare services.4 However, the issues of integration and coordination have been a part of the National Mental Health Strategy (the Strategy) documents for almost 20 years, with little evidence that much progress has been made on a broad scale.5 Each successive government Report, Policy and Plan, as well as independent evaluations, have noted these areas have not been well progressed and reiterate that they are central to effective health and social care for people with mental illness.6-8

The First National Mental Health Plan defined integration as '[a] network of specialised mental health services within the general health system' with reference to coordination, continuity of care and case management, but little elaboration on the mechanisms underpinning each of these terms.9 Haggerty and colleagues10 argued that this confusion of terms is a worldwide phenomenon and provided a useful working definition of coordination in mental healthcare. They stated that more than any other condition managed in primary healthcare, coordination in mental health involves continuity of contact between a team of providers and the consumer that facilitates the flexible delivery of services to meet individual need.10 Services across health and social care boundaries and with a team, rather than a single provider, are central features of mental healthcare and Haggerty et al. suggested tools such as flexible care plans facilitate care over time. They argued that continuity is the way individuals experience coordination (a service level concept) and propose three components of continuity: informational, relational and management. Informational continuity entails the use of information, usually in the form of medical records, to bridge past and current care and plan for future needs. Relational continuity provides an ongoing therapeutic relationship between a consumer and providers. Management continuity ensures a coherent and responsive approach by teams of providers, including the use of shared plans and protocols to facilitate access to a broad range of services. The authors suggested 'continuity is achieved when services are delivered in a complementary and timely manner' (p.1220) and that the flexibility to adapt to consumers' changing needs is particularly important in mental healthcare. They concluded, however, that continuity is more than just processes such as case management: it is the perception by consumers and providers that care is 'connected and coherent' (p.1221) and that addressing continuity at the individual level can contribute to better care and coordination at the service or organisational level.10

In this paper, we review Australian policy and programs related to care coordination in mental health to explore the extent to which these dimensions of continuity have been addressed. Taking three examples of Australian government initiatives attempting coordination of care in mental health, we assess what lessons have been learned that can inform the developing health reforms.

Methods

Australian Commonwealth government websites were searched systematically for mental health policy documents. Relevant documents that dealt with mental health as part of broader health system reform were also accessed. To investigate formal research on initiatives identified in policy documents, exploratory searches of PubMed, Medline and PsycINFO were conducted by combining the general terms 'coordination' or 'integration' and 'mental health' or 'mental illness' and 'Australia', or by searching for the name of the specific program (e. …

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