Older persons mental health in rural Australia: Testing a model for integration

Introduction and problem: There is significant unmet need for mental health care for older persons in Australia, with those living in rural communities particularly disadvantaged in terms of availability and access to services. Linkages and collaboration between health and social services has been advocated in national policies, though integrated primary mental health care for older people in the Australian context remains problematic. Purpose and theoretical basis: A participatory research project is being undertaken (October 2013-January 2015) to test a network model to plan and manage the development of integrated primary mental health care for older people, with one rural region in South Australia as a case study. The theoretically informed model [1,2] consists of components (linkages and enablers) and processes (facilitated reflective practice) with the aim to optimize problem solving in situ. The testing of the model is to ascertain if the process of facilitated reflection can help participating organizations to improve integration. Method: A mixed methods case study approach included analysis of the policy context and Organizational Network Analysis to determine the structure and function of links between services, and barriers and enablers to effective linkages. Consumers and their carers will also be interviewed to explore client journeys to care. Meetings are being held over the course of the project for stakeholders (champions and managers) from a range of relevant organizations to reflect on the data. Findings and Conclusion: Early results suggest that the reflective process is effective in engaging stakeholders in identifying problems in the network and participating in the development of solutions at the local level. Formalized processes to support integration however are lacking, with a fragmented policy and funding context creating an unsupportive authorizing and resourcing environment. Three levels appear to impact on how the network is functioning: 1. Local level linkages; 2. Management level linkages; 3. Policy and funding. Implications of emerging findings on the development of sustainable integration of services for older people with mental health issues will be discussed.