Evaluation of the national mental health strategy

Linkages

Page last updated: December 1997

The historical isolation of mental health services produced a culture in which consumers of mental health services were denied access to support services in many sectors. The emphasis given by the Strategy to this area recognises that access to services such as housing, employment, social support and general health care, is essential for people with a mental illness to function in the community.

The Strategy objectives on intersectoral links (Table 6) emphasise:

  • the elimination of discrimination in access to programs by people with mental disorders and
  • the development of formal policies and mechanisms to ensure access to needed programs and services in other sectors.
The 1995 National Mental Health Report commented that "given the complexity of the systems which need to change ... the area of intersectoral linkages is one of the most difficult facing the National Mental Health Strategy."

Several of the critical structural steps have been taken.
  • Anti discrimination legislation is in place in the Commonwealth and the majority of States and Territories, which provide protection against discrimination on the grounds of mental illness.

  • Action has been taken by all jurisdictions to develop formal agreements with departments administering human service programs required by people affected by mental illness.

  • At the Commonwealth level, initiatives have been targeted at improving access to employment support and tailoring social security to ensure people with mental illness are able to access entitlements.

  • State and Territory initiatives have focused on improving access to public housing. The more advanced States have extended this to development of joint protocols with other key government agencies including police, ambulance authorities, corrections services and child protection.
Earlier reports of mental health consumer consultations indicated that access to housing and employment were the highest priority services for improvement. Evidence presented in the 1995 National Report suggests that the initiatives taken in these areas are beginning to show benefits.
  • Mental health consumers increased from 10% of total clients assisted by the Commonwealth Rehabilitation Service in 1991 to 23% in 1995. Over the same period, mental health consumers increased from 2% to 15% of total persons assisted by Commonwealth-funded disability support services which focus on employment in the open labour market

  • Joint housing support initiatives commenced between the health and housing departments in at least four States, with places expected to increase over the next twelve months.
The Area Case Studies concluded that, compared with other evaluation focus areas, least progress has been made in linking mental health services with other services. This view was endorsed in the national consultations.

Building service linkages as a means of improving overall consumer outcomes is not yet regarded as core business by most local mental health services. Roles and responsibilities are not clearly defined, and relationships between mental health services and other local agencies tend to develop on an ad hoc basis.

Guidelines are needed to assist public mental health services in developing formal relationships with external agencies. Responsibilities and objectives also need to be reflected in local area plans. Only one State has prepared such materials.Top of page

For this to work, priorities are needed. In addition to housing and employment, the local area and national consultations highlighted the following additional areas as requiring greater effort than has been the case to date.
  • General practitioners
    Improving links with GPs holds the greatest potential to improve outcomes for a large number of people with mental health problems. Such links need to go beyond discussions around individual cases, and extend to broader issues of training, consultation and referral pathways that make best use of the health resources available in the area.

  • Community support agencies
    Organisations operating outside the mental health sector have potential to play a greater role in supporting people in the community who are affected by mental illness. Relevant services include home help, family support, respite and recreation. Better access needs to be facilitated through agreements developed between the central funding authorities and linkages at the service delivery level.

  • Emergency services
    Police and ambulance services typically interact with mental health consumers in highly stressful circumstances, sometimes with associated danger. Recent well documented cases of the use by police of firearms to control a psychiatric emergency have highlighted the need for improved police training and better linkages to local mental health services.

  • Corrections and criminal justice systems
    Links between the mental health system and the legal and correction systems are essential to ensure adequate referral and treatment of people with a mental disorder who commit crimes. Current arrangements are described as inadequate.

Table 6: Intersectoral Linkage Policy Objectives

Table 6 is presented as a list in this HTML version for accessibility reasons. It is presented as a table in the PDF version.
  • To eliminate any explicit or implicit discrimination against those with severe mental health problems and mental disorders in programs and services within and outside the health sector.
  • To develop formalised policy and planning arrangements at Commonwealth, State, Territory and area/regional levels to ensure that all programs relevant to those with severe mental health problems and mental disorders adequately address their needs.
  • To encourage interagency links and service delivery arrangements at the local and area/regional level to ensure access to services for people with severe mental health problems and mental disorders reflects their relative need for those services.

Source: National Mental Health Policy, 1992

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