System-level intersectoral linkages between the mental health and non-clinical support sectors: a qualitative systematic review

Abstract

ObjectivesConcerns about fragmented mental health service delivery persist, particularly for people with severe and persistent mental illness. The objective was to review evidence regarding outcomes attributed to system-level intersectoral linkages involving mental health services and non-clinical support services, and to identify barriers and facilitators to the intersectoral linkage process. MethodsA systematic, qualitative, review of studies describing attempts to coordinate the activities of multiple service agencies at the policy, program or organisational level.Electronic databases Medline, PsycINFO and EMBASE were searched via OVID from inception to July 2012. ResultsOf 1,593 studies identified, 40 were included in the review -26 in adult and 14 in vulnerable youth populations. Identified mechanisms to promote positive system-level outcomes included: interagency coordinating committees or intersectoral/interface workers engaged in joint service planning; formalised interagency collaborative agreements; a single care plan in which the responsibilities of all agencies are described; cross-training of staff to ensure staff culture, attitudes, knowledge and skills are complementary; service co-location; and blended funding initiatives to ensure funding aligns with program integration. Identified barriers included: adequacy of funding and 3 technology; ensuring realistic workloads; overcoming 'turf issues' between service providers and disagreements regarding areas of responsibility; ensuring integration strategies are implemented as planned; and maintaining stakeholder enthusiasm. ConclusionsSystem-level intersectoral linkages can be achieved various ways and are associated with positive clinical and non-clinical outcomes for services and clients. Some linkage mechanisms present greater implement challenges than others (e.g., major technology upgrades or co-location in geographically remote areas). In some instances (e.g., colocation) alternative options may achieve equivalent benefits. Publication bias could not be discounted, and studies using high-quality research designs are scarce. The limited information base applicable to system-level integration argues strongly for evaluation of the models that evolve in the rollout of the national Partners in Recovery initiative.

Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review

“…leading to a lack of shared information about particular patients [26]. This barrier was especially mentioned in studies on integrated mental healthcare provision [2526]. …”

“…Although such barriers are mentioned in various studies of integrated care in inter-organisational settings – partly as the main focus and partly as a by-product while elaborating on other facets of inter-organisational collaboration – so far no systematic review of the relevant literature has been compiled. Various literature reviews focus on inter-organisational collaboration and networks in different industries [222324], but few of these explicitly addresses barriers [122526], often with a very indication-specific focus on healthcare settings. Several empirical works address barriers to the delivery of integrated care in inter-organisational settings, but mostly focus on aspects specific to their case [1127] and lack theoretical embedding.…”

Smoking and Mental Illness: A Bibliometric Analysis of Research Output Over Time

“…22 In terms of mental health specific settings, the increased attention on community/ outpatient mental health facilities, relative to inpatient facilities, could be speculated to be a positive reflection of a less exclusive focus on severe diagnoses or patients experiencing acute illness episodes, but may also reflect a change in the delivery of mental health care towards a greater focus on community based services in some countries. 59,60 In Australia, it has been estimated that 64% of smokers with a 12-month mental disorder had not accessed any health services over a period of 1 year. 19 The increasing focus on settings other than health care settings observed in this study may therefore indicate an increased recognition of the need to address smoking among these community living people with mental illness who do not regularly access the health system.…”

Addressing Unmet Sexual Health Needs among Black Adolescents with Mental Illnesses

“…Third, in an ideal world, all agencies would be able to co-locate HIV prevention services with mental health treatment; however, we acknowledge the challenges posed by limited resources (Whiteford et al, 2014). Where co-location is not feasible, we suggest innovative pairings between mental health agencies and AIDS Service Organizations (ASOs), or comparable community-based sexual health providers, for service provision.…”