Abstract
Aims: Integration of private psychiatrist services and public mental health services is a priority area outlined in the second National Mental Health Plan and directly encouraged through the federally funded National Demonstration Projects in Integrated Mental Health Services. My aim was to describe the experiences of a group of participants in established shared care arrangements and thereby contribute to developing understandings about them.
Method: I interviewed participants in the eleven existing shared care arrangements (study group): case managers, private psychiatrists, patients and carers. To add context, I compared the study group with the rest of the clinic patients (comparison group) on a range of socio-demographic and diagnostic variables and a subset of the comparison group on an outcome scale (HoNOS).
Results: All patients had established contact with their psychiatrist before the shared care arrangement. The majority was assigned case managers following heavy use of acute public services. Psychiatrists played little role in this decision. As the professionals described it, the arrangements clustered into three groups: ‘collaborative’, ‘problematic’ and ‘neutral’. Collaborative arrangements had good communication, shared goals, clear roles and capacity to respond to changing needs, that left patients feeling confident. Some carers felt the arrangement supported them. The only significant difference between the groups was the lower prevalence of Community Treatment Order (CTO) and lower scores on three HoNOS items for those in the study group.
Conclusion: Collaborative Care arrangements can offer patients a wider choice of treatment possibilities and offer some modes of treatment that would otherwise not be available. Patient needs can be diverse and are not restricted to a particular diagnostic group. They can offer a satisfying professional experience. These findings, together with the result that the study group was broadly similar to the rest of the clinic patients, except in regard to the need for a CTO, invites the question of whether these are underutilised arrangements. The variable outcome noted in this study calls for caution. Some of the arrangements were characterised by difficulties around professional communication and relationship. This resulted in role confusion, leaving professionals feeling burdened and privately doubting the usefulness of the arrangement. Case managers in this relationship expressed this more frequently. Responsiveness to patient need was diminished and patients had a lower expectation that the professionals would jointly address the problems on their behalf. Features that facilitate these arrangements working well are presented.