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Table 3 Barriers to mental health service integration at Floresco

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

Barriers/challenges Stakeholders mentioned …
Bringing staff from four different NGOs together to work as one team • Differences in organisational culture (values, philosophy, tolerance of risk)
• Differences in organisational policies, procedures and practices
• Having to negotiate over seemingly minor issues
• Challenges — for Aftercare, NGO partners, and staff themselves — related to staff supervision
Barriers to integrating with the MHS • The fact that this initiative was driven by NGOs, rather than mandated by government
• Systemic constraints on the MHS’s ability to participate
Barriers to systematic information sharing • System barriers preventing NGOs from accessing the MHS information system
• Practical difficulties preventing MHS staff from using Floresco’s information system
• Differing views among the partner NGOs about the importance of record-keeping
• Co-located services not using the shared client information system
• Difficulty of ensuring that users of the shared client information system enter data correctly and consistently
Resourcing challenges • Insufficient NGO funding to support necessary components of the service model
• Insufficient NGO funding to enable employment of more appropriately qualified, skilled and/or experienced staff to respond to clinical need
• Insufficient MHS resources to enable co-location of staff at Floresco
Staffing problems • High staff turnover, particularly among support workers
• Difficulties in recruiting suitable NGO staff, both support workers and managers
• Long delays in filling support worker positions
• Difficulties maintaining commitment to the integration vision in the context of management changes
• Mental health workforce recruitment difficulties in the Ipswich area
Recruiting and retaining GPs and private mental health practitioners • Constraints on charging a fee
• Lack of incentives and support for private practitioners
Responding to demand • Higher-than-expected demand for services
• Insufficient resources to meet demand
Responding to clinical need • Higher level of clinical need than expected
• Inability to meet demand for private practitioners
• Insufficient capability among support workers to respond to clinical need
Operating as a consortium • Additional and more complex staff management problems for Aftercare
• Ongoing clinical governance problems
• Lack of benefits for clients
• Unequal partnerships
• Tension between the need to collaborate in the Floresco service model and the pressure to compete in the context of the incoming National Disability Insurance Scheme
Inconsistent leadership and governance • Over-reliance on the commitment of key personalities
• Difficulties maintaining the commitment to collaboration in the face of several management staff changes, particularly within Aftercare
• Inconsistent commitment to the Governance Committee among consortium partners
• Uncertainty about an appropriate governance model
• Lack of strategic focus by the Governance Committee