This is the final report of a project that focused on the integration of mental health and drug and alcohol services for homeless people in two states and documented the mechanisms and effectiveness of such linkages.
Service integration involves ‘joint working’ in one form or another. This can range from loose collaborative arrangements, such as referral of clients and good communication between staff in different organisations to full integration where the resources of different organisational units are pooled in order to create a new organisation.
The study found that specialist homelessness, drug and alcohol and mental health services are all providing support in domains other than their direct area of specialization, suggesting a degree of internal integration within the relevant agency. For example, 40 per cent of specialist homelessness services provide mental health services and 35 per cent also provide drug and alcohol support.
Integration was higher in Melbourne than Perth. However in both cities, practitioners desired a greater depth of integration than what was achieved. Both actual and desired levels of integration fall short of the two highest levels of integration, namely, cooperation and collaboration.
Services in both Perth and Melbourne, which engaged in formal partnerships also scored highly in terms of synergy, leadership, partnership efficiency, administration and management and resources. However, services generally lacked critical ingredients for integration such as sharing and participation between services and client referrals. Clients from more integrated services were generally more likely to report positive outcomes across a range of client integration measures (e.g. having a case manager) than were clients of less integrated services.
There is widespread interest from practitioners and clients for increased service integration. But policy-makers should note the current tendency for integrated responses to come from within, rather than between, agencies. Integrated care by a single agency with multiple service functions is likely to be the most promising way forward because agencies clearly wish to retain their independence. However service integration is highest between services in the same domain rather than between services in different domains so there is a need for peak bodies to work to bridge these divisions, and also to facilitate sharing of information and relationships between staff in different services.
Authored by Paul Flatau, Elizabeth Conroy, Monica Thielking, Anne Clear, Sarah Hall, Alicia Bauskis, and Matthew Farrugia.