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health sector has long been ‘under-funded’ and ‘overlooked’ in the allocation of mental health service funding. However, on the question of the more specific relationship between individual agencies and government funding bodies, several organisations provided positive feedback, describing open and ongoing communication. The ACT Mental Health Strategy and Action Plan 2003-2008 recognised the need for the ‘flexible allocation of resources drawn from a range of departments and programs’. 59 In addition, the Strategy commits the Government to ensure that the resource allocation process is both ‘transparent and accountable to all stakeholders’. 60 These commitments are welcome, though have not been fully implemented with consultation participants calling for the diversification of funding streams and increased funding transparency. The burden of accountability reporting was consistently identified as a challenge, with community organisations concerned that they were expected to have public service standards of management, without adequate financial and logistical support to achieve and maintain these standards. 61 Service specifications, performance measures and reporting requirements all impose a heavy time and human resource burden on community sector organisations. This accountability burden poses a particular threat to the viability of small organisations, who need additional support to be able to discharge these obligations without detrimentally affecting service delivery. Finally, organisations reported the loss of non-core funded functions (e.g. innovative program development, planning and evaluation, change management, research) as a result of outcomes funding. The service delivery relationship between community and government services: formal and informal General Given the focus of this paper, most of the organisations consulted had a primary relationship with MHACT rather than other government departments. Other organisations providing broader services and funded by another department gave information about their relationship with MHACT to inform discussion of inter-sectoral linkages. By contrast, some organisations talked about their primary relationship with another Department, for example, Housing ACT. When asked about their relationship with MHACT, community mental health organisations described it variously as: ‘improving’; dependant on particular staff; ad hoc and focussed on particular clients (rather than systemic and permanent), ‘difficult’, ‘very negative’ and ‘characterised by poor communication’. One participant expressed the view that her organisation’s efforts to maintain this relationship were unreciprocated. Another suggested that difficulties arose because of conflict between recovery and medical models of service delivery. However, several participants described a positive relationship with MHACT, particularly with policy staff. Others indicated that their referral relationship with MHACT was good, but this was not a widespread response. Community organisations also reported referral links with the government housing service, Housing ACT, and some had tenancy agreements with Housing ACT for residential programs they administered. This kind of partnership was seen as vital for the separation of landlord and support service. Finally, some participants expressed concern and frustration about the poor relationship ___________________________________________________________________________________________________________________________ 59 At 59. 60 At 60. 61 The Australian Psychiatric Disability Coalition Inc and The Head Injury Council of Australia Inc, Trying Desperately: The Role of Non-Government Organisations in an Integrated System of Care for People with Psychiatric Disability or Acquired Brain Injury, Tony Wade and Associates P/L, Brisbane, May 1995 at 6. 19 Towards an integrated mental health service system in the ACT•June 2007 NO WRONG DOORS
etween MHACT and Housing ACT, perceiving that little was changing on the ground despite rhetoric about improved inter-departmental cooperation. The nature of the relationship between community and government mental health services is affected by a number of other issues. Principally, these are differences in service delivery attitude, approach and philosophy. A number of participants described the attitude of clinical services towards community services in negative terms as ‘arrogant’ and ‘dismissive’. This perception was reported to translate into low staff morale. Some consultation participants suggested that relations between community sector service providers and government services in the ACT compared unfavourably with that in other states and territories, and are perceived to be on a less equal basis in the ACT than some other jurisdictions, despite the Social Compact. Definitional differences between the two sectors can also pose challenges to cooperation. At a general level, the clinical, pathological approach to mental health within the clinical sector contrasts with more organic concepts used in community services. Some community organisations expressed frustration that clinical language remained the dominant paradigm in the mental health field. Further, definitional and diagnosis differences generate gaps in service delivery. Examples include individuals with personality disorders, those experiencing a serious, though not ‘severe’ mental health episode and those with a dual diagnosis. It was commonly reported that individuals experiencing a ‘serious’ mental health episode, although posing a potential risk to the individual and to the general community, are often not able to receive Crisis Assessment and Treatment Team (CATT) assistance. This leaves community sector organisations facing conflicting duties of care to client, employees and volunteers. A number of consultation participants highlighted this problem, and noted that, upon being discharged from their service, clients were only able to access CATT assistance after they finally ended up in an Emergency Department. Several community organisations from outside the mental health sector (though potentially overlapping in function with this sector) reported that their primary interaction with government mental health services was with the CATT team. This suggests the need for better integrated and improved early detection and intervention systems as well as the development of crisis support options, for example, step up/step down facilities and crisis houses. We welcome the recent Government commitment of resources to developing a step up/ step down facility. Formal inter-agency agreements (MOUs) Relations between community sector and government services vary in their level of formality. Thus, a number of organisations in the mental health and alcohol and drug sectors reported entering memoranda of understanding (MOUs) with MHACT or ACT Health. It should be noted that a number of these agreements have been initiated by MHACT, which has been welcomed by the sector. Of these agreements, some were perceived to be working effectively, designating roles and responsibilities, referral pathways and protocols for service cooperation and joint case management. Other MOUs were seen as less effective, either due to a lack of awareness of the agreement within government services (due to staff turnover or perceived departmental attitudes towards the sector), or because the protocols of collaboration established in the MOU have proven unworkable. Low levels of staff awareness about MOUs impedes communication and cooperation between services, and results in a loss of trust in the Department. Other organisations reported that negotiations towards an MOU had been abandoned, with each party proposing a protocol not acceptable to the other party. In some of these cases, parties had managed to agree on a protocol in lieu of an MOU. The ACT Mental Health Strategy and Action Plan 2003-8 committed the Government to the development of partnerships, the preparation of formal agreements and the ‘promotion of the terms and application of agreements amongst relevant policy and operational personnel within the participating organisations.’ 62 ___________________________________________________________________________________________________________________________ 62 At 9. NO WRONG DOORS Towards an integrated mental health service system in the ACT•June 2007 20
Page 2 and 3: no wrong doors Towards an integrate
Page 4 and 5: Table of contents ABOUT ACTCOSS....
Page 6 and 7: executive summary The purpose of th
Page 8 and 9: 9. Youth aged between 18 and 25 yea
Page 10 and 11: part 1: introduction BACKGROUND AND
Page 12 and 13: care’ initiatives as a key fundin
Page 14 and 15: A belief in the value of coordinati
Page 16 and 17: to effective collaboration include:
Page 18 and 19: THE ACT SOCIAL COMPACT Relations Go
Page 22 and 23: Consultations conducted in the deve
Page 24 and 25: 5. Commit to the development, with
Page 26 and 27: Failures of service coordination an
Page 28 and 29: esults for the individual concerned
Page 30 and 31: development of clear guidelines of
Page 32 and 33: and by the reluctance of some parti
Page 34 and 35: payments, they may live in public h
Page 36 and 37: work most effectively when working
Page 38 and 39: seeking help with other services. U
Page 40 and 41: health and social and emotional wel
Page 42 and 43: eferences Government policy documen
Page 44 and 45: appendix B CONSULTATION QUESTIONS T

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