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
Objective. To review Australian mental health initiatives involving coordination of care.
Methods. Commonwealth government websites were systematically searched for mental health policy documents. Database searches were also conducted using the terms 'coordination' or 'integration' and 'mental health' or 'mental illness' and 'Australia'.We assessed the extent to which informational, relational and management continuity have been addressed in three example programs.
Results. The lack of definition of coordination at the policy level reduces opportunities for developing actionable and measurable programs. Of the 51 mental health initiatives identified, the three examples studied all demonstrated some use of the dimensions of continuity to facilitate coordination. However, problems with funding, implementation, evaluation and competing agendas between key stakeholders were barriers to improving coordination.
Conclusions. Coordination is possible and can improve both relationships between providers and care provided. However, clear leadership, governance and funding structures are needed to manage the challenges encountered, and evaluation using appropriate outcome measures, structured to assess the elements of continuity, is necessary to detect improvements in coordination.
What is known about the topic? The issues of integration of services and coordination of care have been a part of the National Mental Health Strategy documents for almost 20 years, but reports and evaluations continually note a lack of solid progress on these reforms.
What does this paper add? This paper examines how the key elements of continuity that underpin coordination have been addressed in three examples of Australian mental health initiatives aimed at improving integration and coordination.
What are the implications for practitioners? Coordination of care for mental health is possible and can improve both relationships between providers and care provided, but attention should be paid to the role of informational, relationship and management continuity in program design and implementation.
Received 23 May 2011, accepted 12 October 2011, published online 25 May 2012
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. …