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Stakeholder barriers and facilitators to mental health service integration: a qualitative study using the theoretical
Adam Searby1, Dianna Burr2, Alison M Hutchinson2
1Monash University School of Nursing & Midwifery, Melbourne, Australia. Adam.Searby@monash.edu.
Aims And Objectives:
We aimed to determine the organisational and systemic barriers and facilitators to achieving mental health service integration in a region of the State of Victoria, Australia.
Background:
A consensus definition for mental health service integration is lacking, with literature referring to the 'joining up' of mental healthcare and physical healthcare to achieve more holistic care that is focussed on the needs of the consumer. There have been several attempts at integrating mental health services with various healthcare providers, with varying results.
Design:
Qualitative interviews conducted with key stakeholders were analysed using the Theoretical Domains Framework, an implementation science framework designed to identify influences on behaviour relating to the implementation of evidence in healthcare.
Methods:
In consultation with a local agency with deep knowledge of mental health service delivery in the region, we recruited stakeholders with extensive experience and knowledge of mental health services; these stakeholders included clinical managers, senior clinicians and leaders of mental health service consumer groups. The interview guide was aligned with the Theoretical Domains Framework. Semi-structured audio-recorded interviews were conducted with stakeholders, and data were analysed according to the Theoretical Domains Framework domains.
Findings:
From interviews with 16 stakeholders, several barriers to mental health service integration in the region were identified, including workforce capability, funding arrangements and stigma towards some consumers of mental health services. Conversely, several facilitators were identified that could aid in service integration being implemented, including worker and clinician commitment to patient-centred care principles and the ability to provide the right care at the right time.
Conclusions:
Although there is good evidence for service integration as an overarching model of mental health service delivery, implementation in some regions has been hampered by extensive barriers. This paper provides recommended strategies to overcome barriers, in addition to facilitators that could be leveraged to achieve mental health service integration.
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