Abstract
Objectives: Psychiatric services have moved from the physical institution. However our relationship to our communities may continue to be shaped by attitudes which constitute a “virtual” institution. This paper aims to explore some challenges we face in developing psychiatric services which are grounded in and responsive to community needs.
Methods: Some barriers to developing responsive services are explored. These include: residual institutional assumptions, dated and limited notions of “community” psychiatry, poor role delineation for public and private psychiatric services and a focus on clinical interventions not balanced by careful consideration of effective delivery systems for those interventions.
The paper gives two examples of approaches to these issues, involving GPs and a public mental health service in joint development of systems of care. The first is a system for treating anxiety disorders based on systematic assessment by GP's, use of a self-guided CBT manual, and targeting of specialist mental health resources to complex or non-responding patients. Positive service outcomes have included high rates of GP participation and satisfaction. Clinical outcomes show that the system has delivered an effective clinical intervention.
In the second a system of care for depression is being developed. This system involves provision of a range of treatment resources and other supports to GPs, systematic coordination of GPs and the public mental health service as an identified “Depression Treatment Network” and changes to triage, assessment and treatment processes within the mental health service.
Some of the difficulties encountered and lessons being learned in developing these systems will be discussed.
Conclusions: It is possible for a mental health service to begin to develop in a way that responds to a broader range of community needs. To do so requires local solutions. It also requires a broader engagement with and commitment to meeting these needs, and a willingness to look beyond the “virtual institution”.