Pathways of recovery: preventing further episodes of mental illness (monograph)

Service access and responsiveness

Page last updated: 2006

Relapse prevention is based on the availability of timely and appropriate service responses from diverse service sectors. This requires appropriate supply, organisation, deployment, education and training of the mental health workforce. Firstly, the distribution and composition of the mental health workforce has to be responsive to population needs for continuing support, and innovative solutions to encourage greater supply and equity of access must be developed. In most jurisdictions, and almost universally in rural and remote areas, the capacity of both clinical and community support services needs to be increased.

Fundamentally, mental health care services need to be able to respond outside acute and crisis situations. This calls for a different type of service response, with a lower threshold of service need required to enable people to get an effective response when they are experiencing their early warning signs. A wider range of service responses and varying levels of care are required – from acute inpatient care to a range of supported accommodation options, as well as support for self-management within the community.

When you pick up early warning symptoms ... people need to be back in the system, but not back in the acute end. —Clinician
Early intervention has been recognised as a function of the mental health care system that requires innovation and action. Early intervention requires a mental health care system geared toward acting quickly and effectively, with minimal invasiveness and in a non-stigmatising manner, recognising the rights and needs of consumers and their families and carers. Primary care, and general practice in particular, are fundamental to effective early intervention by being in a position to recognise changes in the mental health status of consumers and ensuring that there is an appropriate and agreed service response. This requires strong partnerships with specialist mental health services who must respond when primary care services identify a need. Many jurisdictions have Memorandums of Understanding between their Divisions of General Practice and public mental health services and these linkages are constantly being developed and improved. However, in many jurisdictions there is still some way to go to achieve the type of early intervention responses that are required.

The strengths of the specialist mental health, primary care and psychiatric disability sectors need to be brought together and, while retaining their distinctiveness, recognise and enhance their synergy. This would encourage true partnerships to develop, thereby enabling seamless transitions from acute care to follow-up and support services, and back to acute care if necessary.

The issue is around return pathways. We need a semi-permeable membrane, a lower threshold back into a higher level of care. —Clinician
Relapse prevention needs to commence in the treatment phase of the first episode and be ongoing, possibly for the entirety of a person's life. Delivering mental health care that is responsive to the many, diverse and changing long-term needs of consumers and their families and carers, requires working within complex systems of service delivery. This means developing models of integrated care, whereby innovative funding and service delivery methods support the coordination and delivery of continuity of care across episodes of illness, across the lifespan, and across services and sectors. This is a challenging task necessitating expanding service frameworks within and beyond the health system, to incorporate mental health and primary care, as well as disability, accommodation and welfare services, and education, employment and other sectors that impact on the recovery of people with mental illness. Models of these expanded and integrated frameworks are being developed in some areas and these approaches need to be encouraged and more widely adopted. Top of page

Inequities regarding access to some of the support services that are essential to recovery and impact on risk of relapse must be eliminated; in particular, access to disability services, accommodation, and domiciliary care need attention, but also access to employment, education and training, and income support. It is essential that barriers to support services and all discriminatory practices that restrict access for people with mental illness be removed.

There is need for more outreach and assertive community treatment options, particularly to reach people who are socially and economically disadvantaged, such as homeless people with mental illness and those with complex comorbidities, such as harmful alcohol or other drug use. Strong partnerships are essential and effective partnership models are beginning to evolve in some areas, particularly between mental health, drug and alcohol, and accommodation services. However, further development of partnership models is required, along with ways to sustain and embed partnerships as standard practice.

They are assertive outreach staff - they don't take referrals, they find people, their job is to link people with existing services. 80% of their target group are people with a serious mental illness who are in caravan parks and rooming houses and such like. We also have outposted to work with those people an RDNS nurse, so the three of them go out. For a while we also had a mental health clinician, so it was a team of four people. They would just visit people and say 'how are you going' and make sure they were ok. The nurse got to see they were ok, the clinician got to see they were ok, the two linkage people made sure they were getting the supports – the generic mainstream supports from the community that they needed. It worked really well, it was a great model. I think it had a big impact on people who were isolated and people didn't have to exhibit relapse signs, severe signs, before they got support. —Psychosocial rehabilitation service provider
It is important to recognise the role of the community sector, and non-government organisations in particular, which are a major source of continuing care and support for people in the community. In most jurisdictions, services that impact on the risk and protective factors for relapse and that provide accommodation, psychiatric rehabilitation, and support services to consumers and their families and carers, are provided mostly by the non-government sector. However, while the demands on non-government organisations have increased significantly over the past decade, their funding base remains limited. This inequity needs to be addressed if these organisations are to have the resource base that enables them to effectively provide services for consumers and carers. Access to psychosocial and psychiatric rehabilitation services will be facilitated by better resourcing and improved coordination and integration. Considerable effort needs to be applied to building up the community support and non-government sector to enable these services to meet levels of population need and to be integrated within a broader and more comprehensive mental health care framework that is easier for consumers, their families and carers, and services providers to access.