Commissioning for health and community sector reform: perspectives on change from Victoria

2020 ◽  
Vol 26 (4) ◽  
pp. 332
Author(s):  
Kate Silburn ◽  
Virginia Lewis
Keyword(s):  
Mental Health ◽  
State Government ◽  
Service Providers ◽  
Community Support ◽  
Models Of Care ◽  
Community Services ◽  
System Level ◽  
Reform Process ◽  
Structured Interviews ◽  
Competitive Tendering

Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.

scholarly journals Co-designing Services for Youth With Mental Health Issues: Novel Elicitation Approaches

2019 ◽  
Vol 18 ◽  
pp. 160940691881624 ◽  
Author(s):  
Gillian Mulvale ◽  
Sandra Moll ◽  
Ashleigh Miatello ◽  
Louise Murray-Leung ◽  
Karlie Rogerson ◽  
...  
Keyword(s):  
Mental Health ◽  
Design Thinking ◽  
Service Providers ◽  
Essential Elements ◽  
System Level ◽  
Mutual Understanding ◽  
Health Issues ◽  
Prototype Development ◽  
Mental Health Issues ◽  
Research Narrative

Experience-based co-design (EBCD) is an innovative, evidence-based approach to health and social system change based on principles of participatory action research, narrative and learning theory, and design thinking. Unique elicitation strategies such as experience mapping, trigger videos, and prototype development are used in EBCD to engage service users and service providers in a collaborative process of identifying touchpoints and solutions to system-level problems. In this article, we present findings from interviewing a purposeful sample of 18 participants (4 youth, 6 service providers, 6 family members, and 2 employers) across three co-design projects designed to address either mental health or employment services for youth (aged 16–24) with mental health issues in one urban center. Through interviewing participants, perceptions were explored relating to three elicitation techniques: creating experience maps, creating and viewing trigger videos, and co-designing visual “prototype” solutions. Analysis of participants’ comments indicated that these techniques can be powerful tools to foster mutual understanding and collaborative ideas, but they require a social, spatial, and temporal context that optimizes their value. A “safe space” is needed within which the essential elements of elicitation—building trust, finding voice, sharing perspectives, and creating a common vision—can occur. Three core, overlapping processes of co-design elicitation were identified: “building common perspectives,” “building mutual understanding,” and “building innovation.” We present a conceptual framework depicting the interplay of processes and elicitation techniques, essential to building mutual understanding and innovation during the EBCD process.

‘Getting our voices out there’: acceptability of a mental health participation programme for young people with out of home care experience in Australia

2019 ◽  
Vol 35 (5) ◽  
pp. 1085-1093
Author(s):  
Jessie Rafeld ◽  
Kristen Moeller-Saxone ◽  
Sue Cotton ◽  
Simon Rice ◽  
Katherine Monson ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Home Care ◽  
Service Planning ◽  
System Level ◽  
Mental Health Training ◽  
Structured Interviews ◽  
Care Experience ◽  
Out Of Home Care ◽  
Meaningful Participation

Abstract Youth with experience of out-of-home-care (OoHC) typically have poorer mental health than their peers in the general population, and lack opportunities to contribute to service planning. Promoting mental health through leadership training may improve young people’s mental health and facilitate system change. The Bounce Project is a pilot youth-leadership mental health training programme co-designed with young people who have experienced OoHC. In this study, we evaluated the Bounce Project from the young people’s perspectives to explore the acceptability, successes and limitations of the training to promote the participant’s mental health and their contribution to system level change. Thirteen young people aged 18–26 years old who had experienced OoHC and participated in the Bounce Project were interviewed. Semi-structured interviews were conducted and thematically analysed. Four major themes were thereby identified: making their mark; opportunities for growth; redefining roles and pitfalls of research participation. Participants valued the opportunity to have their voices heard, participate in research and learn about mental health. Perceived negative aspects included infrequent participation opportunities, interpersonal difficulties and frustration about the limitations of research including pressure to recruit and restrictive deadlines. Participating in the Bounce Project was a mostly positive experience, but young people also encountered barriers to meaningful participation. Youth with lived experience need more avenues to participate in research and leadership, but research programmes require specific designs that take into consideration the needs of participants and create opportunities for effective and meaningful participation.

“Hear me out”: Experiences of mothers suffering from severe mental illness with health care providers – A qualitative perspective

2017 ◽  
Vol 41 (S1) ◽  
pp. s899-s899 ◽  
Author(s):  
D. Banerjee ◽  
G. Desai ◽  
P.S. Chandra
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Health Care Providers ◽  
Service Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Seeking Help ◽  
Competing Interest

BackgroundContrary to popular myth, majority of mentally ill women are mothers with increasing number of them seeking help. Little is known about their own experiences in this regard and the extent to which their needs are met.ObjectivesTo assess the barriers and facilitators in seeking help from mental health care providers in matters of pregnancy and parenting.MethodsThe study used qualitative design with social constructivist paradigm. A purposive sample of 30 mothers with severe mental illness was obtained. Data was collected through one-to-one in-depth semi-structured interviews. After verbatim transcription, inductive thematic analysis was used to explore transcripts.ResultsMost women considered motherhood “central” to their lives and almost all of them experienced the burden of the “dual role”. Main barriers in seeking help were stigma, treatment side effects, wrong information and time constraints. Whereas self-advocacy, early engagement, education of women and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers as identified were early and direct communication, patient audience and basic guidance in regards to child health and parenting issues.ConclusionWomen who are mothers and also users of mental health services face special challenges in managing the contradictory aspects of their dual identity. Hearing their voices are essential for service provision and ensuring adequate mental health needs. Early and direct intervention along with understanding and addressing critical areas are necessary for proper care of both the mother and child.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The mental health consumer movement and peer providers in Israel

2018 ◽  
Vol 27 (5) ◽  
pp. 420-426 ◽  
Author(s):  
G. S. Moran
Keyword(s):  
Mental Health ◽  
Health System ◽  
Peer Support ◽  
Mental Health System ◽  
Community Integration ◽  
Models Of Care ◽  
Community Services ◽  
Unique Contribution ◽  
Consumer Movement ◽  
The Impact

Self-help peer-support groups in Israel emerged in the 1980s and, over time, dynamically interacted and co-developed with the statutory mental health (MH) system. In this editorial, I outline historical milestones of how the evolution of the Israeli mental health system was influenced by the consumer movement. A brief depiction of the consumer movement history. At first, consumers operated outside of the mainstream MH system. Gradually, consumer groups and institutional personnel joined efforts towards community integration and enhancement of quality of life, pushing forward a person-centered recovery orientation. In turn, some administrators and key stakeholders in rehabilitation community services grew to value the impact of knowledge-by-experience in contemporary mental health care. In this context, over the past decade, peer roles were developed in the mental health system, including consumer-providers in community services and peer specialists in inpatient psychiatric hospitals. The insertion of peer roles into the mainstream MH system is far-reaching, including the placement of a peer-project coordinator within the ministry of health. I describe the unique contribution of peers, as experts-by-experience, to mainstream professional knowledge and practice. I also highlight the potential challenges involved when peer models of care are added to traditional medical models of care. The Israeli case demonstrates how the consumer movement can play an active role in MH systems and be acknowledged and recognised as a partner for changing policy, practice and reshaping formal institutions. In addition, they play a vital role in the development of peer-support services.

Socialization or Social Isolation?

2021 ◽  
pp. 360-380
Author(s):  
Kim Heyes
Keyword(s):  
Mental Health ◽  
Support Groups ◽  
Online Community ◽  
Mental Health Problems ◽  
Service Providers ◽  
Healthcare Providers ◽  
Community Support ◽  
Research Findings ◽  
Global North ◽  
The Uk

This research project specifically examines the experience of online community support groups as reported by users. The project began out of concern that healthcare providers in the Global North are directing people with mental health problems to online services, without seemingly understanding the impact that this may have on the individuals. The research findings will be of particular interest to mental health practitioners and service providers in the UK and elsewhere in the Global North, and aims to influence decisions made for policies around developing new online mental health services.

Working Together to Connect Care: a metropolitan tertiary emergency department and community care program

2018 ◽  
Vol 42 (2) ◽  
pp. 189 ◽  
Author(s):  
Debra Harcourt ◽  
Clancy McDonald ◽  
Leonie Cartlidge-Gann ◽  
John Burke
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Case Management ◽  
Community Support ◽  
Care Program ◽  
Community Services ◽  
Management Approach ◽  
Frequent Users ◽  
Frequent Attendance ◽  
Working Together

Objective Frequent attendance by people to an emergency department (ED) is a global concern. A collaborative partnership between an ED and the primary and community healthcare sectors has the potential to improve care for the person who frequently attends the ED. The aims of the Working Together to Connect Care program are to decrease the number of presentations by providing focused community support and to integrate all healthcare services with the goal of achieving positive, patient-centred and directed outcomes. Methods A retrospective analysis of ED data for 2014 and 2015 was used to ascertain the characteristics of the potential program cohort. The definition used to identify a ‘frequent attendee’ was more than four presentations to an ED in 1 month. This analysis was used to develop the processes now known as the Working Together to Connect Care program. This program includes participant identification by applying the definition, flagging of potential participants in the ED IT system, case review and referral to community services by ED staff, case conferencing facilitated within the ED and individualised, patient centred case management provided by government and non-government community services. Results Two months after the date of commencement of the Working Together to Connect Care program there are 31 active participants in the program: 10 are on the Mental Health pathway, and one is on the No Consent pathway. On average there are three people recruited to the program every week. The establishment of a new program for supporting frequent attendees of an ED has had its challenges. Identifying systems that support people in their community has been an early positive outcome of this project. Conclusion It is expected that data regarding the number of ED presentations, potential fiscal savings and client outcomes will be available in 2017. What is known about the topic? Frequent attendance at EDs is a global issue and although the number of ‘super users’ is small compared with non-frequent users, the presentations are high. People in the frequent attendee group will often seek care from multiple EDs for, in the main, mental health issues and substance abuse. Furthermore, frequent ED users are vulnerable and experience higher mortality, hospital admissions and out-patient visits than non-frequent users. Aggressive and assertive outreach, intense coordination of services by integrated care teams, and the need for non-medical resources, such as supportive housing, have positive outcomes for this group of people. What does this paper add? This study uses international research findings in an Australian setting to provide a testing of the generalisability of an assertive and collaborative ED and community case management approach for supporting people who frequent a metropolitan ED. What are the implications for practitioners? The chronicling of a process undertaken to affect change in a health care setting supports practitioners when developing processes for this cohort across different ED contexts.

scholarly journals Globalisation and psychiatry

2003 ◽  
Vol 9 (6) ◽  
pp. 464-470 ◽  
Author(s):  
Brendan D. Kelly
Keyword(s):  
Mental Health ◽  
Large Scale ◽  
Service Providers ◽  
Models Of Care ◽  
Focused Attention ◽  
Challenges And Opportunities ◽  
The Usa ◽  
Training Policy ◽  
Positive Engagement ◽  
The Relationship

Globalisation means crossing borders. It is a complex, large-scale social phenomenon that presents to mental health services both challenges and opportunities. These relate to the increased cultural diversity of service users and service providers; the effects of migration on mental health; and the implementation of international protocols in relation to training, policy and education. In the aftermath of 11 September 2001 in the USA, the relationship between large-scale social change and mental health has also focused attention on the concepts of anomie and social capital. An explicit return to the principles of biopsychosocial psychiatry and a positive engagement with globalisation will advance the development of effective, evidence-based models of care appropriate to the changing needs of patients.

Marginalised young people’s healthcare journeys: Professionals’ perspectives

2018 ◽  
Vol 77 (6) ◽  
pp. 692-704 ◽  
Author(s):  
Fiona Robards ◽  
Melissa Kang ◽  
Kate Tolley ◽  
Catherine Hawke ◽  
Lena Sanci ◽  
...  
Keyword(s):  
Young People ◽  
Health System ◽  
Access To Health Care ◽  
System Analysis ◽  
Service Providers ◽  
Cross Sectional Study ◽  
Models Of Care ◽  
Sampling Frame ◽  
Structured Interviews ◽  
Cross Sectional

Introduction: The pursuit of social justice includes a commitment to health equity for marginalised young people. Health professionals are central to marginalised young people’s engagement and access to health care and their navigation of health systems. They are also uniquely positioned to shed insight into structures and inefficiencies within the health system, including the role of technology, and to advocate for system change. Methods: This qualitative cross-sectional study employed in-depth semi-structured interviews with 22 health service managers and experienced clinicians to better understand service providers’ perspectives. The sampling frame comprised professionals from different sectors and levels of the health system. Analysis used Grounded Theory methods. Results: Three major themes were identified in the data: (1) intersectionalities – understanding the complexity of multiple disadvantage; (2) health system fragmentation – leading to inefficiencies, inertia and advocacy; and (3) services needing to be ‘turned on their head’ – rethinking service delivery and models of care. Conclusion: A better understanding of marginalised young people’s healthcare experiences, including the complexities of multiple disadvantage, and how this contributes to health inequalities could lead to more welcoming and respectful services. Services can reconceptualise their roles by reaching out to young people, both physically and online, to make the navigation of the health system easier. Marginalised young people’s healthcare journeys can be supported by advocates that help them navigate the health system.

scholarly journals Integrating human‐centred design into the development of an intervention to improve the mental wellbeing of young women in the perinatal period: the Catalyst project

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tatiana Taylor Salisbury ◽  
Katie H Atmore ◽  
Inocencia Nhambongo ◽  
Muanacha Mintade ◽  
Luciana Massinga ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Women ◽  
Service Providers ◽  
Maternal Mental Health ◽  
Community Support ◽  
Mental Wellbeing ◽  
Young Mothers ◽  
Delivery Strategy ◽  
The Impact ◽  
Human Centred Design

Abstract Background Mental wellbeing during pregnancy and the year after birth is critical to a range of maternal and infant outcomes. Many mental health interventions fail to incorporate stakeholder perspectives. The Catalyst Project aimed to work with key stakeholders in Mozambique to develop interventions and delivery strategies which were in-line with existing evidence and the needs, goals, and priorities of those both directly and indirectly involved in its success. Methods A qualitative, human-centred design approach was utilised. Focus-group discussions, individual interviews, and observations with young women (aged 16–24 years), their families, community leaders, service providers and government were used to better understand the needs, priorities and challenges to mental wellbeing of young women. These findings were triangulated with the literature to determine priority challenges to be addressed by an intervention. Stakeholder workshops were held to identify potential solutions and co-develop an intervention and delivery strategy. Results The 65 participants comprised 23 young pregnant women or new mothers, 12 family members, 19 service providers and 11 staff from the Ministry of Health. Participants highlighted significant uncertainty related to living situations, financial status, education, social support, and limited knowledge of what to expect of the impact of pregnancy and parenting. Family and community support were identified as an important need among this group. The Mama Felíz (Happy Mama) programme was developed with stakeholders as a course to strengthen pregnancy, childbirth and child development knowledge, and build positive relationships, problem-solving and parenting skills. In addition, family sessions address wider cultural and gender issues which impact adolescent maternal wellbeing. Conclusions We have developed an intervention to reduce the risk of poor maternal mental health and gives young mothers hope and skills to make a better life for them and their children by packaging information about the risk and protective factors for maternal mental disorders in a way that appeals to them, their families and service providers. By using human-centred design to understand the needs and priorities of young mothers and the health and community systems in which they live, the resulting intervention and delivery strategy is one that stakeholders view as appropriate and acceptable.

scholarly journals Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M.-J. Fleury ◽  
G. Grenier ◽  
L. Gentil ◽  
P. Roberge
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Family Medicine ◽  
Adolescent Psychiatry ◽  
Organizational Support ◽  
Service Providers ◽  
System Level ◽  
Youth Centers ◽  
Adult Psychiatry ◽  
Child Adolescent Psychiatry

Abstract Background Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and impact of SRP in adult and child-adolescent psychiatry on the capacity of service providers in primary care and youth centers to treat patients with mental health disorders (MHD). Methods Data included 126 self-administered questionnaires from SRP and semi-structured interviews from 48 SRP managers. Mixed methods were used, with qualitative findings from managers complementing the SRP survey. Comparative analyses of SRP responses in adult versus child-adolescent psychiatry were also conducted. Results Psychiatrists dedicated a median 24.12 h/month to the SRP function, mainly involving case discussions with primary care teams or youth centers. They were confident about the level of support they provided and satisfied with their influence in clinical decision-making, but less satisfied with the support provided by their organizations. SRP evaluated their impacts on clinical practice as moderate, particularly among general practitioners (GP). SRP working in child-adolescent psychiatry were more comfortable, motivated, and positive about their overall performance and impact than in adult psychiatry. Organizational barriers (e.g. team instability) were most prevalent, followed by system-level factors (e.g. network size and complexity, lack of resources, model inflexibility) and individual factors (e.g. GP reluctance to treat patients with MHD). Organizational facilitators included support from family medicine group directors, collaboration with university family medicine groups and coordination by liaison nurses; at the system level, pre-existing relationships and working in the same institution; while individual-level facilitators included SRP personality and strong organizational support. Conclusion Quebec SRP were implemented sparingly in family medicine groups and youth centers, while SRP viewed their overall impact as moderate. Results were more positive in child-adolescent psychiatry than in adult psychiatry. Increased support for the SRP function, adapting the model to GP in need of more direct support, and resolving key system issues may improve SRP effectiveness in terms of team stability, coordination among providers, access to MH services and readiness to implement innovations.

Sign in / Sign up

Export Citation Format

Share Document