One barrier to mental health integrated care which can certainly be removed
Mental Health services are often described as a Cinderella service at a time when 1 in 4 people experience some kind of mental health problem. (Source: Mental Health Foundation). To improve this, complex barriers to integrated mental health care must be removed.
Why integrated mental health care is so difficult to achieve
Running services for people with mental ill health is an enormous challenge clinically, “working in mental health is not like fixing broken legs” (Tim Smith, The Guardian 15.6.15). And this challenge is amplified when structuring integrated services. There is however, one aspect of integrated mental health care which it is certainly possible to address.
We often only ever hear about mental health services when things go wrong. The media appear to have a hotline to any complainant.
The reorganisation of regions, structures and organisations coupled with tightening financial constraints can cause disruption and disconnection of services rather than integration.
So to see this report highlighted in the news recently, while disappointing, was not a surprise: Mental health care in England 'inadequate'.
Mental Health services “inadequate” makes for a good headline. In fact if you dig deeper you find that this was about A&E services dealing with mental health issues rather than specialist mental health trusts. The impression of disarray remains, and people’s confidence is hit.
But I was struck by a comment further down the article. The CQC has said in their report (which was the source of the story) that “local authorities, NHS trusts and clinical commissioning groups are failing to work together to make sure that people in their local areas have access to crisis care around the clock.”
It is the same story of integration. Trusts that have merged, authorities that have taken new responsibilities, hospitals and community services under pressure…integrating what they do is assumed rather than planned for. And the detailed work necessary to make it happen just gets pushed down the agenda.
Integration needs to be everywhere: from the compatibility of your IT systems to the impact of your annual leave request forms on service delivery.
What can be done to help achieve integrated mental health care?
The Mental Health Trust 2013 report Crossing Boundaries: Improving integrated care for people with mental health problems identified nine factors that impacted on the provision of good integrated care for people with mental health needs.
The first factor identified in the report was information sharing systems. To support the effective day-to-day provision of integrated care to people with mental health problems a compatible information system within and across different organisations is essential.
This is one barrier to integrated mental health services which can certainly be removed in three key, relatively straightforward, steps.
Undertake an Assessment of Information Managment and Technology Service priorities to ensure that they are supported by the most effective use of information and IT solutions, including governance, structure, operational capacity and training and support.
Determine Service Delivery Options and an Implemntation Plan– an understanding of the options and a plan for the delivery of integrated information and IT services.
Implement your findings and plans to deliver a compatible information system within and across different organisations.
Integration costs in terms of time and money, but pays much greater dividends in the medium and long-term. In our experience, a fully integrated organisation sees huge benefits to the delivery of their day to day work. When you are streamlined and everyone knows where they are, and there are integrated systems in place to support this, then things fall into place.
If services integrate, then services improve, and one barrier to mental health integrated care, incompatible information systems, can certainly be removed. Have a look at our work with Devon Partnership NHS Trust.
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