The future of community-centred health services in Australia: 'When too many beds are not enough'

Rosen, Alan; Gurr, Roger; Fanning, Paul; Owen, Alan

doi:10.1071/ahv36n3_re

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…[1][2][3][4][5][6] We have had more than 20 years of warnings that the mental health system is built on a hospital-based and fragmented model, which promotes neither recovery nor inclusion. 1,7,8 Despite the evidence reiterated in recent reports, [1][2][3][4][5] there are few signs of change.…”

Section: Introductionmentioning

confidence: 61%

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Fernández

Gillespie

Smith‐Merry

et al. 2017

Aust. Health Review

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Objective Australian mental health care remains hospital centric and fragmented; it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care; (2) an absence of services providing acute day care and non-acute day care; (3) low availability of specific employment services for people with a lived experience of mental ill-health; and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.

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Section: Introductionmentioning

confidence: 61%

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Fernández

Gillespie

Smith‐Merry

et al. 2017

Aust. Health Review

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“…Although one could argue that ‘too many beds’ is not the solution, it is important to recognize the high acuity of adolescents admitted to inpatient care (Rosen et al . ). One Canadian study sample found that 87% of admitted adolescents had thoughts of injuring themselves prior to admission, 77% did engage in nonsuicidal self‐injury (NSSI), and 67% had made an attempt to end their life prior to admission (Preyde et al .…”

Section: Introductionmentioning

confidence: 97%

“…In terms of access to care, many countries continue to struggle with the limited number of adolescent inpatient beds to meet the demand (Buchanan 2014;Geller & Biebel 2006;Kadvany 2015;Mackee 2018;Merrillees 2014). Although one could argue that 'too many beds' is not the solution, it is important to recognize the high acuity of adolescents admitted to inpatient care (Rosen et al 2012). One Canadian study sample found that 87% of admitted adolescents had thoughts of injuring themselves prior to admission, 77% did engage in nonsuicidal self-injury (NSSI), and 67% had made an attempt to end their life prior to admission (Preyde et al 2014).…”

Section: Introductionmentioning

confidence: 99%

What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review

Hayes

Palmer²,

Hamilton

et al. 2019

Int J Mental Health Nurs

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Limited research exists regarding the therapeutic operations of adolescent mental health inpatient units, particularly in terms of nonpharmacological therapeutic interventions. This review collates what is known about reported nonpharmacological therapeutic interventions for young people admitted to general or non‐disorder‐specific adolescent mental health inpatient settings. A descriptive review of this nature was not located in the literature. The aim was to identify what is currently known about reported nonpharmacological therapeutic interventions. The purpose was to consider gaps and contribute to further work being undertaken in describing an exemplary inpatient model of care for adolescents. Sources included CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO. Studies included were those published in English, between the years 2000 and 2018. Exclusions included residential, community, outpatient, forensic settings, and studies detailing pharmacological interventions. Ten studies were identified. This descriptive review provides an objective foundation to inform an exemplary inpatient model of care currently being investigated. There is a critical need to understand these interventions to identify key components of an inpatient model of care. Such knowledge will provide guidance for future services seeking to create an exemplary model of care. Furthermore, these results can influence current practice by improving quality and delivery of inpatient care.

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“…However, shortcomings in the process of deinstitutionalisation, largely political and economic, mean the development of community mental health services has been inadequate and is being eroded. [5][6][7][8][9] Although approximately 70 jurisdictions worldwide have schemes enabling involuntary community treatment orders (CTOs), 10 they remain extremely controversial. There is much debate arising from what is a heterogeneous evidence base for their effectiveness, as well as a range of ethical, legal and political dilemmas raised by their use, including issues surrounding the use of coercion and the accountability of health practitioners and policy makers to provide adequate mental health and other social services.…”

Section: Introductionmentioning

confidence: 99%

How shortcomings in the mental health system affect the use of involuntary community treatment orders

Light¹,

Robertson²,

Boyce³

et al. 2017

Aust. Health Review

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Objective. The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs).Methods. A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n = 5), carers (n = 6), clinicians (n = 15) and members of the Mental Health Review Tribunal of NSW (n = 12). Data were analysed using established qualitative methodologies.Results. Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services.Conclusion. The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. MODELS OF CAREWhat is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment.The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.

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The future of community-centred health services in Australia: 'When too many beds are not enough'

Cited by 8 publications

References 17 publications

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations

What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review

How shortcomings in the mental health system affect the use of involuntary community treatment orders

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