Health professional partnerships and their impact on Aboriginal health: an occupational therapist's and Aboriginal health worker's perspective

OBJECTIVE: To describe the extent and nature of demonstrated professional partnerships between occupational therapists and Aboriginal health workers in rural and remote communities of North Queensland. The study identifies ways in which professional partnerships improve client services and enhance occupational therapy outcomes through exploring the aspects of communication, collaboration and bridging cultural boundaries. DESIGN: Data collected via in-depth, semistructured telephone interviews. SETTING: Aboriginal and mainstream health and human service organisations in rural and remote North Queensland. Rural and remote areas were identified using the Accessibility and Remoteness Index of Australia codes. PARTICIPANTS: Seven participants working in rural and remote areas of North Queensland, comprising four occupational therapists and three Aboriginal health workers. All participants were female. RESULTS: Participants identified five core themes when describing the extent and nature of professional partnerships between occupational therapists and Aboriginal health workers. Themes include: professional interaction; perception of professional roles; benefits to the client; professional interdependence; and significance of Aboriginal culture. According to participants, when partnerships between occupational therapists and Aboriginal health workers were formed, clients received a more culturally appropriate service, were more comfortable in the presence of the occupational therapist, obtained a greater understanding of occupational therapy assessment and intervention, and felt valued in the health care process. CONCLUSIONS: This study substantiates the necessity for the formation of professional partnerships between occupational therapists and Aboriginal health workers. The findings suggest that participation in professional partnerships has positive implications for occupational therapists working with Aboriginal clients and Aboriginal health workers in rural and remote regions of North Queensland.     

Queensland extended care services for people with severe mental illness and the role of occupational therapy

Background:  People with serious mental illness in Queensland who require extended rehabilitation may be treated in extended inpatient mental health services. Two of these extended inpatient services, hospital and community-based 'Extended Treatment and Rehabilitation Units (ETRUs) and Community Care Units (CCUs)', are described, including the aims, objectives, philosophy and service delivery.
Methods:  A quality project involving occupational therapists working in these settings, as well as a consumer and carer, provides different perspectives concerning these relatively new health services in Queensland.
Results:  Two main occupational therapy roles were identified: case management and occupational therapy-specific roles (including assessment and intervention). The consumer and carer perspective is also presented.
Conclusion:  These services provide a positive option for people with high levels of functional disability as a result of mental illness and also for their carers. They provide environments with many exciting opportunities and challenges for occupational therapists working in mental health.     

The National Mental Health Plan in Chile: 10 years of experience]

Dealing with mental health problems is undoubtedly an increasingly important public health responsibility around the world. In Chile, because of the changes in the epidemiological profile of the population, the lifetime prevalence of mental and behavioral disorders has reached 36%. In response, the Ministry of Health of Chile, through its Mental Health Unit, prepared the National Plan for Mental Health and Psychiatry. The Plan establishes objectives, strategies, and steps to improve the well-being and mental health of Chileans. This piece describes the model of care for mental health and psychiatry used in Chile's public health care system, analyzes the main difficulties encountered and the achievements made in the 10 years that the Plan has been in place, and makes recommendations for improving the Plan. Over the 10-year period, the new model for mental health and psychiatry has managed to make a place for itself in the public health care system. Indicators show that the beneficiaries of the public health care system in Chile now have greater access to mental health services than before the new model of community care was established, have broader health care coverage, and receive better quality services.     

The Nature of Emerging Practice in Occupational Therapy: A Pilot Study

The profession of occupational therapy is responding to changes in the health care system by expanding the contexts and models for service provision, typically referred to as emerging practice. As a pilot study, a survey was completed by 174 occupational therapists to gather information and opinions about emerging practice. Results indicated occupational therapists hold diverse perceptions about emerging practice settings and services as well as the role and significance of emerging practice within the profession. Occupational therapists engaged in emerging practice described numerous rewards and challenges inherent within the process of developing and delivering services. The findings indicate continued professional dialogue and research are needed to support the development and efficacy of occupational therapy services in emerging settings and roles.     

The Australian Health Care Agreement 1998–2003: Implications and strategic directions for occupational therapists

Funding for public health services in Australia is provided to the States and Territories from the Commonwealth. Contractual obligations for how these monies are allocated are detailed in the Australian Health Care Agreement 1998 –2003, which has replaced the Medicare Agreement 1993–1998. Key issues identified in the new Agreement, which will impact on occupational therapy services, include arrangements for mental health services, palliative care initiatives, casemix, health system reform, and private health insurance. Particular implications stem from the proposed reforms to the health system. These include the quality agenda, outcome-based funding and evidence-based practice. Other themes identified include future opportunities for occupational therapists working in health services and the imperative to form collaborative partnerships with consumers and other health care providers. The Australian Health Care Agreement is analysed and suggestions given for strategic directions for occupational therapists to consider.     

Sources of stress experienced by occupational therapists and social workers in mental health settings

This study examined the sources of stress experienced by occupational therapists and social workers employed in Australian public mental health services and identified the demographic and work-related factors related to stress using a cross-sectional survey design. Participants provided demographic and work-related information and completed the Mental Health Professionals Stress Scale. The overall response rate to the survey was 76.6%, consisting of 196 occupational therapists and 108 social workers. Results indicated that lack of resources, relationships and conflicts with other professionals, workload, and professional self-doubt were correlated with increased stress. Working in case management was associated with stress caused by client-related difficulties, lack of resources, and professional self-doubt. The results of this study suggest that Australian occupational therapists and social workers experience stress, with social workers reporting slightly more overall stress than occupational therapists.     

Challenges for psychosocial rehabilitation services in the Lisbon Metropolitan Area: A qualitative approach

In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community‐based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio‐occupational units (SOUs) of the LMA. Semi‐structured interviews were performed with all SOUs’ managers of the LMA (n = 13). Information regarding service user characteristics was collected based on service records (n = 344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community‐based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As a conclusion, it is highlighted the current inequality between services and the need to contemplate a life‐course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low‐ and middle‐income countries passing through similar reforms.     

Future directions for mental health services in Australia

Abstract: The last decade has seen a marked increase in the attention given to mental health policy and services at both a state and national level. Mental health consumers, carers, service providers, and a number of professional bodies have contributed to the scrutiny of what had been a relatively neglected area. The release of Australia's first National Mental Health Policy is a milestone in the development of a national focus on mental health promotion, prevention and the provision of enhanced services for persons with mental disorder and mental health problems. This paper discusses briefly the directions promoted in the national policy, including mental health promotion, reorientation of mental health services, the nongovernment sector, consumer rights, intersectoral links, service quality, research and evaluation.     

Implementation of diagnosis-related mental health programs: impact on health care providers

Mental health services are in the midst of change in different countries. In Quebec (Canada), the government has adopted a Mental Health Action Plan (2005-2010). In this context, 2 psychiatric institutions have developed and implemented a mental health services organization model based on diagnosis-related mental health programs and support for frontline services. This article presents the impact on health care providers of implementation of diagnosis-related mental health programs in the context of transformation of mental health services.     

Public policy and mental illnesses: Jimmy Carter's Presidential Commission on Mental Health

President Jimmy Carter's Presidential Commission on Mental Health was intended to recommend policies to overcome obvious deficiencies in the mental health system. Bureaucratic rivalries within and between governments; tensions and rivalries within the mental health professions; identity and interest group politics; the difficulties of distinguishing the respective etiological roles of such elements as poverty, racism, stigmatization, and unemployment; and an illusory faith in prevention all influenced the commission's deliberations and subsequent enactment of the short-lived Mental Health Systems Act. The commission's work led to the formulation of the influential National Plan for the Chronically Mentally Ill, but a system of care and treatment for persons with serious mental illnesses was never created.     

Collaboration and referral practices of general practitioners and community mental health workers in rural and remote Australia

OBJECTIVE: To assess an important part of Australia's National Mental Health Strategy by examining the collaboration and referral practices between general practitioners and community mental health workers in rural and remote areas. DESIGN: Semistructured interviews. SETTING: Rural and remote health service region in Australia. PARTICIPANTS: In total, 31 general practitioners and 14 mental health workers. RESULTS: Meaningful collaboration and referral practices between general practitioners and mental health workers are prevented by contradictory and ambiguous definitions involving professional roles and mental health. A pattern of negative collaboration was further magnified by the rural and remote context. CONCLUSION: The implementation of Australia's National Mental Health Strategy faces serious problems in rural and remote area due to the negative collaboration and referral practices between general practitioners and mental health workers.     

Implementing the Public Health Social Work Forward Plan: a research-based prevention curriculum for schools of social work.

In 1985, the Division of Maternal and Child Health of the U.S. Public Health Service funded a major working conference entitled "Public Health Social Work in Maternal and Child Health: A Forward Plan." Curriculum recommendations for schools of social work were made, including a recommendation for the integration of health and mental health content in the education of social workers within a public health conceptual framework. In 1986, the National Institute of Mental Health funded a three-year program to develop and evaluate a research-based prevention training curriculum for dissemination to schools of social work and other primary care professional schools. This article examines the Michigan Prevention Training and Curriculum Development Project from the perspective of the recommendations of the Public Health Social Work Forward Plan.     

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

Single mothers and the use of professionals for mental health care reasons

In the present study, we examine whether higher rates of mental health service use observed among single-parent mothers is due to greater need (psychopathology) or other factors (predisposing and enabling characteristics) using a socio-behavioural model of health care use. We use data from two large surveys in Canada (the 1994-95 National Population Health Survey and the 1990 Ontario Mental Health Supplement). The bivariate results from both surveys revealed that single-parent mothers were two to three times more likely than married mothers to have sought professional help for mental health reasons over a 12-month period. Multivariate analyses showed that differences in predisposing and enabling characteristics between single and married mothers accounted for very little of the relationship between family structure and service use. Rather, differences in the prevalence of psychiatric disorders accounted for the higher use of services among single mothers. Single mothers are more likely than married mothers to seek professional help for mental health concerns. The use of services appears equitable in that need (higher rates of psychopathology) is the major factor differentiating use between married and single mothers. Further work should examine differences in pathways into formal care between single and married mothers.     

Understanding Occupational Therapy: Nursing and Physician Assistant Students' Knowledge About Occupational Therapy

Until very recently, occupational therapy services have been provided in institutional settings and have followed the medical model. The escalating costs of hospital care have been the primary incentives for moving patients out of acute settings and thus increasing the need for occupational therapy services in the community. Yet, relatively few therapists have moved from the medical model even though the need exists and legislation encourages that service be provided in the least restrictive alternative. Further, occupational therapists have been slow to adopt distinct strategies for planning with patients for their roles and needs after treatment even though the heart of the occupational therapy philosophy centers on adaptation to life roles. This paper explores the current trends away from institution-based health care and towards a continuum of health and social services, and the roles for occupational therapists in community settings. Occupational therapists are urged to act as facilitators in assisting patients to move successfully from active treatment to independence in whatever settings they find themselves.     

A case against generalisation of mental health occupational therapy in Australia

Background/aim: In 2009, the World Federation of Occupational Therapists International Advisory Group on Mental Health conducted a global survey that yielded data on mental health occupational therapy practice. The Australian dataset reflected aspects of the current situation of the Australian mental health occupational therapy workforce. Of particular interest were resource availability, workforce recruitment and retention, and perception of the future of mental health occupational therapy. Methodology: Using a cross‐sectional survey design, quantitative and qualitative data were gathered electronically over a one‐month period. Manual analysis indicated themes common to mental health occupational therapists across a framework of professional areas. Results: Findings suggested that role blurring negatively affected workforce retention. Workforce recruitment and retention were complicated by resource shortages. Some Federal Government initiatives were perceived as only partially beneficial to the profession. Conclusions: Survey respondents believed that mental health occupational therapy was a potential growth area particularly where occupational therapy specific skills were retained.     

Practical strategies for working with indigenous people living in Queensland,Australia

Internationally, occupational therapists have recognized the need to provide culturally appropriate services for indigenous people. This study explored experiences, perspectives and practical strategies of occupational therapists working with Aboriginal and Torres Strait Islander people living in rural and remote areas of Queensland, Australia. Semi-structured interviews were conducted with eight occupational therapists who had at least 12 months' experience providing services to Aboriginal and Torres Strait Islander people in health, rehabilitation or education services. Key themes identified in the data focused on strategies for facilitating effective communication with individuals and families, and collaborating with other service providers. The role of Aboriginal Liaison Officers or Indigenous Health Workers was emphasized by participating therapists. Participants identified resources that they perceived as useful in their practice, such as cross-cultural training and access to indigenous health workers. Other resources suggested for further development included information about learning styles of indigenous people and information about cultural variations between specific Aboriginal and Torres Strait Islander communities. The small number of participants limits generalizability of the findings. However, therapists can decide on the relevance of strategies to their own workplaces. Suggestions for further research focused on improving occupational therapy services for indigenous people in Australia. These include an investigation of therapy goals with indigenous people, and interviews with indigenous Australians and indigenous health workers about their experiences and perceptions of occupational therapy.     

'They don't treat you like a virus': youth-friendly lessons from the Australian National Youth Mental Health Foundation

Young people experience high rates of mental health problems, but very few access professional mental health support. To address the barriers young people face in accessing mental health services, there is growing recognition of the importance of ensuring services are youth-friendly. Indeed, almost a decade ago, the World Health Organisation developed a youth-friendly framework for services to apply. Yet, this framework has rarely been evaluated against health initiatives for young people. This article begins to address this gap. Using 168 semi-structured, qualitative interviews with young service users, this paper explores the extent to which the Australian National Youth Mental Health Foundation, also called headspace, applied the WHO's youth-friendly framework which emphasises accessibility, acceptability and appropriateness (AAA). It argues that headspace was largely successful in implementing an AAA youth-friendly service and provides evidence of the importance of tailoring services to ensure they are accessible, acceptable and appropriate for young people. However, it also raises questions about what youth-friendly service provision means for different young people at different times. The findings suggest that youth friendliness should be applied across different stages of interaction (at initial engagement and in the ongoing relationship between patient and clinician) and at different levels (the environment the care is provided in, within policies and procedures and within and between relationships from receptionists to clinicians).     

Telemedicine for rural and remote child and youth mental health services

The E-Child and Youth Mental Health Service was designed to provide children and adolescents in Queensland with access to specialist mental health consultations using telemedicine. A project officer provided a single point of contact for referral management and clinic coordination, thereby reducing barriers of access to the service. Over a six-month period from November 2004, 42 point-to-point videoconferences were conducted to nine sites in Queensland. Three multipoint conferences were also conducted. Eleven videoconferences (24%) were arranged for administrative purposes, and 34 (76%) were conducted for the delivery of clinical services (30 patients). The referral and consultation activity suggests an improvement in the capacity of rural and remote mental health service providers to deliver specialist services for children and adolescents.     

NHS commissioning in probation in England – on a wing and a prayer

National guidance in England exhorts Clinical Commissioning Groups [groups of general practices established to organise delivery of National Health Service (NHS) care in their local area (CCGs)] to commission healthcare for those living in the community who are serving non‐custodial sentences called ‘community orders’. This includes ‘approved premises’ – accommodation providing enhanced supervision for offenders and individuals on bail who may present a high risk of harm to the public. In this national survey of CCGs in England, we compared the extent to which healthcare services were commissioned for probationers in 2014 with similar data we collected in 2013. A freedom of information (FOI) request was sent to all CCGs (n = 212) and Mental Health Trusts (organisations commissioned to provide health and social care services to individuals with mental health disorders) (n = 53) in England. Mental Health Trusts were included as they were known to fund mental health services for probation as part of their block funding allocations. A small number of basic questions were asked. The response rate was good with 65% of CCGs (n = 137) and 68% (n = 36) of Mental Health Trusts responding. The findings show that the proportion of CCGs commissioning healthcare for probation reduced from 7% to 1%, with 20% of CCGs stating that funding healthcare for this group was the responsibility of the NHS England Area Teams. There was also a reduction in the proportion of Mental Health Trusts funding healthcare for probation but from a much higher baseline, that is from 70% to 61%. The prevalence of mental health disorders in probation is high, so it was of concern that only 12% of Mental Health Trusts provided a service to support approved premises and just 32% provided clinics in probation. The results are discussed within the context of the NHS reforms and the government's plans in England to reform probation.