The future of community-centred health services in Australia: lessons from the mental health sector

Abstract

Abstract* It is apparent that hospital-dominated health care produces limited health outcomes and is an unsustainable health care system strategy. * Community-centred health care has been demonstrated to be a more cost-efficient and cost-effective alternative to hospitalcentred care, particularly for prevention and care of persistent, long-term or recurrent conditions. Nevertheless, hospitalcentred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. * The reasons for these trends are explored. * The future of community health services in Australia is uncertain, and in some states under serious threat. We consider lessons from the partial dismantling of Australian community mental health services, despite a growing body of Australian and international studies finding in their favour. * Community-centred health services should be reconceptualised and resourced as the centre of gravity of local, effective and affordable health care services for Australia. A growing international expert consensus suggests that such communitycentred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services.What is known about the topic? Community-centred health care has been widely demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care, particularly for prevention and care of persistent, long-term or recurrent conditions, e.g. in mental health service systems. A growing international expert consensus suggests that such communitycentred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services. What does this paper add? Despite this global consensus, hospital-centred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. The reasons for these trends and possible solutions are explored. What are the implications for practitioners? Unless this trend is reversed, the loss of convenient public access to community health services at shopping and transport hubs and the consequent compromising of intensive home-based clinical care, will lead to a deterioration of preventative interventions and the health care of long-term conditions, contrary to international studies and reviews.

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