Coordination of care in Australian mental health policy
Michelle A. Banfield A D , Karen L. Gardner A , Laurann E. Yen A , Ian S. McRae B , James A. Gillespie C and Robert W. Wells AA Menzies Centre for Health Policy, Australian National University, Level 1, Ian Potter House, Cnr Gordon & Marcus Clarke Sts, Canberra, ACT 0200, Australia. Email: karen.gardner@anu.edu.au; laurann.yen@anu.edu.au; robert.wells@anu.edu.au
B Australian Primary Health Care Research Institute, Australian National University, Level 1, Ian Potter House, Cnr Gordon & Marcus Clarke Sts, Canberra, ACT 0200, Australia. Email: ian.s.mcrae@anu.edu.au
C Menzies Centre for Health Policy, University of Sydney, Victor Coppleson Building (D02), The University of Sydney, NSW 2006, Australia. Email: james.gillespie@sydney.edu.au
D Corresponding author. Email: michelle.banfield@anu.edu.au
Submitted: 23 May 2011 Accepted: 12 October 2011 Published: 25 May 2012
Abstract
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.
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