Transforming mental health services for delivery of evidence-based psychosocial treatment: What works in supporting practice change?

Antipsychotic pharmacotherapy helps some people by reducing symptoms of psychosis, however it is not a universally effective approach, and does not necessarily improve the quality of people’s lives. Similarly, while mental... [ view full abstract ]

Antipsychotic pharmacotherapy helps some people by reducing symptoms of psychosis, however it is not a universally effective approach, and does not necessarily improve the quality of people’s lives. Similarly, while mental health case management does improve contact with mental health services, it does not produce change in reductions in symptoms, relapse rates, hospitalisation, or quality of life[1].  Over the past decade, a range of specific psychosocial approaches have emerged with the potential to maximise recovery.  These include therapy for voices, Acceptance and Commitment Therapy, family interventions, vocational support, coaching to support physical well-being and therapies to assist with substance abuse.    The Inner West Area Mental Health Service in Melbourne, Australia, is at the mid-point of implementing a practice reform which offers the exciting prospect of both improved experiences of the service for consumers and carers, and greater work satisfaction for clinicians.   For the 300+ staff employed in the adult programs, there are more opportunities to apply targeted assessment and therapeutic interventions that will bring many exciting challenges and rewards.   However, the reality is that implementation of evidence-based practice in busy clinical services is a labourious and often frustrating enterprise. We describe the development of our vision, the range of “core” and “specific” interventions that underpin the service reform, the range of practical strategies we have found effective in aligning the service culture with our vision and generalising the practice change across community, acute inpatient and residential settings.  Data for presentation includes outcomes of performance monitoring across the domains, engagement in different professional development activities, and consumer and carer satisfaction findings.   

[1] Marshall M¹, Gray A, Lockwood A, Green R Case management for people with severe mental disorders. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD000050. doi: 10.1002/14651858.CD000050.pub2.