Using a Whole System Approach to Service Development in Rehabilitation and Continuing Care Services

Abstract

The past two decades have seen the final stages of the hospital closure programme of Victorian hospitals and a corresponding growth in the number of communitybased services with beds. A mixed economy of care has been encouraged, resulting in a wide range of rehabilitative and continuing-care provision across health, social services, voluntary and private sector providers (Department of Health, 2001; 2002). Correspondingly, the past decade has seen increasing pressure on acute in-patient units, resulting in occupancy rates over 100%, in some cases even as high as 123% (Ford et al, 1998; Sainsbury Centre for Mental Health, 1998). This pressure has been compounded by the considerable number of people who remain on acute wards because of the lack of suitable community alternatives (Fulop et al, 1996). Furthermore, the growth in community services has not always been within the locations where they have been required and as a result many people have been placed away from their local services, relatives and friends (Poole et al, 2002). There are now various pressures across the mental health system causing concern for service commissioners; these include over-occupancy of acute wards, difficulty in accessing low and medium secure facilities and escalating use of beds outside local services, often referred to as OATS (out of area treatments). The latter often results in finances being lost from services that could have been used to develop the capacity and capability of the local system, such as enhancing community mental health team resources to provide supported accommodation. Many commissioners are looking at their local nonacute services to determine whether they can function more effectively to relieve some of these pressures while also assisting in bringing people, and the associated funding, back to the local mental health system from where they came. One method of improving the effectiveness and efficiency of the mental health services of an area is through taking a whole systems approach to development. This paper presents data from three case studies where a whole systems approach to needs assessment and management has been undertaken. The client group concerned was adults with severe and enduring mental illness (non-organic) with rehabilitation or long-term continuing-care needs. None of the local services in these case studies was forensic in nature, although some of the residents came from such backgrounds. Providers included social services, the NHS, and voluntary and private sector organisations.