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development of clear guidelines of responsibility for overall case management.’ 81 The Strategy reports that the MOU established between the two services goes some way to addressing these issues. 82 Finally, the ACT Action Plan for Mental Health Promotion, Prevention and Early Intervention 2006-2008 proposes to ‘extend the collaborative approach developed between alcohol and drug clinical services for people with a co-morbid illness, to develop strategies and services in mental health promotion, prevention and early intervention’ with a specific Action item to ‘strengthen collaboration’. 83 This is a welcome and necessary commitment. At the end of this Part, a number of recommendations are proposed which detail ways in which the Government can support community services to collaborate. HOUSING PROVIDERS AND ACCOMMODATION SERVICES A number of organisations indicated that homelessness was a key issue facing individuals with a mental health condition, particularly for youth and those with a dual-diagnosis. They indicated that there was a current shortage of safe, supported accommodation options, particularly for men. The relationship between community mental health services and community housing providers was better than some other inter-sectoral relationships, but could be improved. There seemed to be few, if any, joint projects between them. That said, a strong partnership exists between the Richmond Fellowship and Havelock House to provide long term accommodation for those with a mental illness. Crisis accommodation services were listed among those non-mental health services that mental health consumers indicated they most commonly accessed. Many consultation participants, whether service provider or consumer, indicated that a high proportion of clients accessing crisis accommodation services have a mental illness. Further, a recent Mental Health Foundation consultation identified the need to develop ‘closer working relations’ with emergency accommodation services. There are a number of existing links between mental health services and crisis accommodation services. Firstly, we understand that some crisis accommodation services have formal relationships with MHACT. Secondly, there are links between some crisis accommodation services and the CATT team. Crisis accommodation services reported that they needed to access CATT services periodically. This follows from the fact that many service-users will be experiencing an acute situation at the time they access crisis accommodation services. For this reason, such services can play a vital role in early intervention and prevention if linked with relevant mental health services. In addition, some supported accommodation services also have links with AOD services. However, there was a lower degree of linkage between accommodation services and community mental health services, with few protocols existing between the two sub-sectors. Finally, the Richmond Fellowship (a mental health service provider) and Havelock House (a community housing service) have an agreement to provide permanent accommodation for people with a mental illness. Havelock House provides housing stock, while the Richmond Fellowship receives funding to support clients in these units. This partnership was established in 1997. Apart from resource sharing, the partnership serves the particular purpose of separating the functions of landlord and support services for mental health consumers. In addition, it maintains a continuity of tenancy after a mental health episode. The program does not receive any joint program funding. The ACT Action Plan for Mental Health Promotion, Prevention and Early Intervention 2006-2008 proposed that the SAAP and mental health community sectors, in addition to rehabilitation providers, participate to ‘increase coordination ___________________________________________________________________________________________________________________________ 81 At 110. 82 At 110. 83 At 24, Action 7.2. 29 Towards an integrated mental health service system in the ACT•June 2007 NO WRONG DOORS
etween supported accommodation programs and vocational and other rehabilitation programs to improve access.’ 84 While this is a constructive proposal, the need for Government support to enhance the capacity of community organisations to engage in collaboration and network-building must again be emphasised. A more detailed discussion of the kinds of support required is developed in the final part of this paper. EMPLOYMENT SERVICES Recent evidence suggests that some three quarters of those of working age with a mental illness in Australia are not in the labour force. 85 Despite this, there are currently only two employment and vocational rehabilitation services in the ACT: the Mental Illness Fellowship and Workways. Both services were consulted during this project and indicated that they had effective referral partnerships with each other (related to the employment readiness of the service user), in addition to relationships with other community services. However, there was a perception expressed by one organisation that relationships between employment or vocational rehabilitation services and the rest of the social service system are fairly poor, with sub-sectors very segregated. Although both organisations outlined the key services with which they were linked, including mental health support and rehabilitation organisations, primary health care services, crisis accommodation services and alcohol and drug services, most relationships were described as ‘ad hoc’, rather than systemic or formal. Interestingly, systemic and working relationships were considered quite distinctly, with relationships classified as either formal, at management level, with no day-to-day shared client management or informal, involving daily contact around clients. This suggested the need to integrate these relationship models. Some particular employment issues were identified around dual-diagnosis clients. Difficult issues were identified in relation to drug and alcohol use in an employment context and an employer’s duty of care. This suggested the need for closer links to be developed between mental health employment services and AOD services, to provide the necessary alcohol and drug support to enable dual-diagnosis clients to maintain or resume employment. Finally, due to the narrowing of the role and function of Commonwealth job capacity assessors, the need for links with other community mental health organisations becomes all the more critical. In the new Commonwealth policy and funding climate, this is the only way that employment services can be provided holistically in a context of broader support structures. PRIMARY HEALTH CARE Primary health care services consulted emphasised the significant proportion of their clients primarily seeking mental health, emotional and social wellbeing assistance. This is consistent with the Productivity Commission’s recent finding that 11.4 in every 100 encounters with a general practitioner (GP) involves mental health problems. 86 Primary health care services consulted included some generic health services, in addition to population specific services, for example, youth and Indigenous health services. What was striking about a number of these population-specific services was their holistic and non-bureaucratic approach to health. Several organisations provided a vast array of services, applying a holistic health philosophy that treated individuals in all of their particular circumstances rather than as belonging to one illness or disorder category. In this respect, some organisations were models of integrated health care. Despite this, some of the services consulted had fairly low levels of awareness of relevant community mental health services. This is partly explained by the fact that they perform an array of services and may have less need to refer on to other organisations, ___________________________________________________________________________________________________________________________ 84 Action 6.5 at 23. 85 Council of Australian Governments, National Action Plan on Mental Health 2006-2011, 2006 at 4. 86 Productivity Commission. Review of Government Service Provision, 2007 at 11.46. NO WRONG DOORS Towards an integrated mental health service system in the ACT•June 2007 30
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 26 and 27: Failures of service coordination an
Page 28 and 29: esults for the individual concerned
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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