actcoss text final.indd - ACT Council of Social Service

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Failures of service coordination and cooperation undermine continuity of care and result in service gaps. A number of the service gaps identified by participants reflect such failures, including: • case management; • coordinated dual-diagnosis services; • discharge planning; • follow-up; • PPEI for Indigenous communities; and • Dual-disability services. The ACT Mental Health Strategy and Action Plan identified the need to develop a collaborative approach to service delivery for clients with complex needs. It should be noted that the Complex Needs Working Group was established in 2005 by the Implementation Group to research effective ways to improve service integration and collaboration. It involves members from government and community services, in addition to consumers, carers and community representatives. The Working Group distributed a discussion paper, held a number of consultations with stakeholders in March-April 2005 and has published a final report on consultations. Further reform proposals are anticipated. These should be taken into account as mental health service reforms are progressed. Formal inter-agency agreements and projects Very few community sector organisations indicated that they had MOUs, or some other kind of formal agreement, with other community sector organisations. Similarly, few consulted organisations had been involved in joint projects with other organisations, with many participants expressing scepticism about joint projects, perceiving them to be ‘too difficult’ or ‘too time consuming’. Several organisations, however, expressed enthusiasm about the prospect of being involved in such projects in the future. Case management There was a low level of community case management generally reported, with some notable exceptions. However, some instances of service coordination around particular service-users were reported to occur. For example, AOD services reported that workers would sometimes initiate and maintain contact with a dual-diagnosis client in a mental health facility, while some mental health and supported accommodation workers indicated that they would maintain contact with clients while in detoxification. These instances of coordination seemed to take place in relation to particular individuals rather than as the implementation of a service coordination strategy. In another example, consumer consultation participants highlighted the role that the ACT Disability, Aged and Carer Advocacy Service (ADACAS) plays in coordinating services for clients (everything from utilities to mental health services), but noted that the service was often functioning at maximum capacity, and unable to assist all those in need. Ultimately, case management was consistently identified as a capacity that the community sector wishes to further develop. This is consistent with the Australian Council of Social Service (ACOSS) Community Sector Survey finding that case management was identified as a priority training need. 77 Referral and information pathways All consultation participants indicated that they had referral and information relationships with other community organisations, either within the same sub-sector (for example, mental health) and/or between organisations in different sub-sectors (for example, primary health and mental health). Some engaged in resource-sharing, co-location and joint projects, though these activities were less common. In many cases, relationships seemed dependant on contacts between particular managers or staff members, and represented an ad hoc rather than coordinated or systemic relationship. The women’s sector was an exception, with an agreed pathway between services and some commitment to a ‘no ___________________________________________________________________________________________________________________________ 77 Australian Council of Social Service, Australian Community Sector Survey Report 2007, ACOSS Paper 145, February 2007 at 92. 25 Towards an integrated mental health service system in the ACT•June 2007 NO WRONG DOORS
wrong door’ policy. Indeed, despite the existence of the links and contacts described above, consumer consultation participants perceived that referral and information pathways were ‘chaotic’, noting that it was particularly difficult to get accurate information about the crisis accommodation capacity of other organisations. Consumers recounted experiences of services being unable to assist them and failing to provide them with links to other services. An examination of specific inter-sectoral relationships The relationship between the ACT mental health community sector and other areas of the community sector varies considerably depending on: • the particular sector area; • the organisations concerned; and • the existence of personal contacts between the management and staff of particular organisations. Some of the primary issues arising around these particular relationships are outlined below. ALCOHOL AND DRUG SERVICES People with a ‘dual-diagnosis’ or ‘co-morbid’ condition were consistently identified during consultations as a primary area of unmet need. A number of organisations suggested that the number of dual-diagnosis service-users had increased in the last few years partly due to increased use of crystal methamphetamine (‘crystal meth’ or ‘ice’), and that such cases were often linked to homelessness. Services reported that the dual-diagnosis population group were frequently ‘shunted’ from service to service, and were unable to have all their service needs met at any particular time. Although most AOD service users with mental health problems can be managed by such services, a person with a severe mental health condition and a moderate or serious drug and alcohol condition may be unable to access residential AOD services until their mental health condition has stabilised. Likewise, dual-diagnosis clients pose challenges for mental health vocational rehabilitation services which have strict prohibitions on drug use within the workplace. Consumers expressed the view that AOD services were easier to access, with less of a diagnosis hurdle, than mental health services. Consultation participants indicated that relations between the mental health and the alcohol and drug sectors continued to be characterised by a mutual lack of awareness, understanding and respect. This is despite recent ACT Government initiatives to better integrate the two sub-sectors. Such sentiments are reflected in the following participant quotes: ‘Never the twain shall meet’. ‘Nobody knows who to talk to’. Organisations consulted particularly highlighted the lack of understanding of problem substance use issues by those in the mental health sector. Alcohol and drug services consulted suggested that they had closer relations with government mental health services than community mental health services. For example, some joint case management occurs between MHACT and AOD community services, but little between the community AOD and mental health sectors. One participant expressed the view that existing case management systems needed to be better streamlined. There seemed to be a fairly low level of awareness, within both sectors, of the particular services and facilities of the other. Some community mental health day programs and vocational rehabilitation services have a strict policy of temporarily suspending service to clients who are under the influence of alcohol or drugs. In this event, though some indicated that they would liaise with relevant AOD services, they did not have a standing relationship with the AOD sector. Others indicated that they were unaware what happened to service users after eviction. AOD services also have difficulty supporting dual-diagnosis clients. One participant reported that she knew of dual diagnosis service users, assessed as mentally stable at the time of admission to a detoxification facility, who then become extremely unwell over the course of several weeks. This can have disastrous NO WRONG DOORS Towards an integrated mental health service system in the ACT•June 2007 26
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 20 and 21: health sector has long been ‘unde
Page 22 and 23: Consultations conducted in the deve
Page 24 and 25: 5. Commit to the development, with
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

actcoss text final.indd - ACT Council of Social Service

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