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Cited by 13Psychiatric care and mental health servicesMental Health and Patient InvolvementMental Health Treatment and Access

A mixed methods evaluation of an integrated adult mental health service model

Open access
Beere, Diana, Page, Imogen S., Diminic, Sandra, Harris, Meredith·2019·BMC Health Services Research
DOI 10.1186/s12913-019-4501-7PMC PMC6791005
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Abstract

Background: The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a ‘one-stop’ mental health service hub. Methods: We conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale — Domains and Stages (RAS–DS) scores at intake and review (n = 108); (2) RAS–DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation. Results: Interviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS–DS measurements, averaging 5 months apart. RAS–DS ‘total recovery’ scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS–DS domains (‘Looking forward’, p < 0.001; ‘Mastering my illness’, p < 0.001; and ‘Connecting and belonging’, p = 0.001). Corresponding improvements, except in ‘Connecting and belonging’, were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant. Conclusions: Despite the lack of a control group and small follow-up sample size, Floresco’s integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.

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  • People with an SMI experience both psychiatric symptoms and disturbances to their psychosocial health.

    “However, given that people with an SMI experience both psychiatric symptoms and disturbances to their psychosocial health (Beere et al. 2019), a model of care in the Australian community that permits a therapeutic approach to be heavily embedded within the case management model of care, rather than as a supplementary or separate component, may be most beneficial.”

    From Effect of community mental health care programs in Australia: A systematic review (2020) · cites this paper as Beere et al. 2019

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Authors
Beere, D., Page, I. S., Diminic, S., & Harris, M.
Affiliations
The University of Queensland (AU)
Corresponding author
Page, Imogen S.
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2019-10-14
Volume
19
Issue
1
Pages
691-691
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-019-4501-7
PMC
PMC6791005
OpenAlex
W2980340764
Cited by
13
References
21
Citations by year
2025: 1 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 4 · 2020: 1
FWCI
2.04
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Queensland Mental Health Commission (n/a)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
integrated mental health services, community mental health, service integration, Recovery Assessment Scale, general practitioners, non-governmental organizations, emergency department presentation, Queensland, mental health services evaluation
MeSH terms
Facilities and Services Utilization, Adult, Mental Disorders, Emergency Service, Hospital, Follow-Up Studies, Hospitalization, Hospitals, Psychiatric, Humans, Inpatients, Mental Health Services, Organizations, Queensland, Program Evaluation

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