Authors: Lil Vrklevski, Sarah Decrea, Russell Roberts, Tessa-May Zirnsak, Lynee English, Chris Maylea, Rosiel Elwyn, Melanie Sherrin, Hazel Dalton, Russell Roberts & Russell Roberts
Event: 2023 The MHS conference - Adelaide
Subject: Integrated Care Services & Physical Health
Type of resource: Conference Presentations and Papers
Presentation 1: Professional Identity and Integrated Care in Public Mental Health Services
Author: Lil Vrklevski
Introduction: Multi-graded positions on community mental health teams have led to blurred boundaries and role overlap between professional groups. The objectives of the research were to determine the impact of Mental Health Service (MHS) multi-graded positions on the strength of professional identity, perceptions of power across disciplines and consumer care.
Methods: The setting was a large metropolitan MHS) and participants were drawn from nursing, occupational therapy, psychiatry, psychology and social work. An on-line survey of four psychometric measures was administered. Data was analysed using inferential statistics.
Results: The response rate was 44%. The average Professional Identity Scale (PIS) scores were Social Work (4.40), Psychology (4.48), Occupational Therapy (4.54), Nursing (4.58) and Psychiatry (4.62). There was a weak positive correlation (r=0.230, n=320, p <.0001) between PIS and time spent on discipline specific activities and between PIS and Power (r=0.359, n=320, p <.0001). Inpatient staff had higher average PIS (µ=45.77) and Power (µ=4.11) scores than community staff PIS (µ=44.80) and Power (µ=3.98).
Discussion: Mental health professionals need skills and abilities that are varied, similar, flexible and adaptable. Role overlap is beneficial and enables a shared understanding. However, generic positions can limit the ability of the team to address the full range of consumer needs and offer holistic care.
Acknowledgements (not included in word count): Lil would like to acknowledge supervisors, Assoc. Prof Kathy Eljiz and Prof. David Greenfield, Dr Mario D’Souza, The SLHD Mental Health Executive in particular Prof. Victor Storm and colleagues in the SLHD for their assistance and support with this research.
Learning objective: Multi-graded positions and too much role overlap results in a loss of professional identity and feelings of disempowerment, professional identity threat and role conflict among disciplines.
Weaver, R., Peters, K., Koch, J., & Wilson, I. ( 2011). Part of the team: professional identity and social exclusivity in medical students. Medical Education, 45(12), 1220-1229.
Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate Medical Journal, 90(1061) 149-154.
Presentation 2: Supporting infant mental health and child rights within an integrated system.
Author: Sarah Decrea
In this presentation we describe Relationships Australia South Australia’s (RASA) current efforts within a service system to prevent and reduce infant abuse and neglect through supporting perinatal infant mental health, using a human rights approach. We argue the promotion of infant mental health is essential for the safeguarding children’s rights as it is critical period of development that shapes lifelong well-being.
Evidence shows that the complexity families are dealing with while experiencing the involvement of child protection services requires an integrated systems approach. This includes targeted interventions prioritizing the mental health needs of infants and children while ensuring they are safe within their family. The focus is child protection however infant and maternal mental health can be negatively impacted by interventions that do not have a child-focussed therapeutic approach. High-quality interactions and relationships between babies and parents are crucial for life-long mental and social health. Maternal/parental stress introduces risks that can impede these interactions, affecting infant mental health development.
Sarah Decrea – Practice Manager Family Led Decision Making has oversight across RASA early intervention and family support services, and being able to grow up strong in culture, Sarah is able to see the benefits of connecting back to culture for healing families from the adverse effects of colonisation and racism. The human rights approach emphasises the importance of addressing the underlying social determinates of mental-health; poverty, social exclusion and discrimination. This presentation concludes that First Nations knowledge and practices provide guidance for both policy makers and practitioners working to support infant mental health and child rights.
Participants to increase their knowledge and practices to include perinatal and infant mental health approaches in supporting families where there are child protection concerns. That connection and pride in First Nations culture is an important foundation of infant, child and adult mental health.
Presentation 3: Research with – not for – Consumers: Reflections on Co-Designing a Qualitative Study on Physical Health for People with Mental Illness
Authors: Russell Roberts, Tessa-May Zirnsak, Lynee English, Chris Maylea, Rosiel Elwyn, Melanie Sherrin, Hazel Dalton& Russell Roberts
Research has shown that people diagnosed with mental illness are likely to die at an earlier age than people without a psychiatric diagnosis, highlighting serious health inequity (Roberts et al 2022), even though their incidence of cancer is the same or lower than the rest of the population (Kisely et al 2016).
The aim of this presentation is to report on the co-design methodology used in a research project to develop a resource for mental health consumers to advocate for their physical health care (or needs). The authorship team understand co-design to be partnership with a group of people in the population that is being studied in the design and execution of research (Roberts et al 2018; Gray et al 2021).
In this project, we recruited people with lived experience of mental illness and experience of physical health concerns to advise us on the conduct of the research. The advisory group met online regularly to make decisions with the research team. Most notably, the group partnered with the researchers in preparing the ethics application and conduct the rapid review of existing evidence. In this presentation, we reflect on how the co-design group were involved and how the process of co-design could have been improved in our project.
Even imperfect consumer engagement in research is better than having none at all. Researchers must be reflective on the process of engaging consumers and report both strengths and limitations
Gray, R., Brasier, C., Zirnsak, T.-M., & Ng, A. H. (2021). Reporting of patient and public involvement and engagement (PPIE) in clinical trials published in nursing science journals: a descriptive study. Research Involvement and Engagement, 7(1), 88–88. https://doi.org/10.1186/s40900-021-00331-9 Kisely, S., Forsyth, S., Lawrence, D. (2016) Why do psychiatric patients have higher cancer mortality rates when cancer incidence is the same or lower? Australian & New Zealand Journal of Psychiatry. 50(3):254-63.
Roberts, R., Johnson, C., Hopwood, M., Firth, J., Jackson, K., Sara, G., et al. (2022) The Potential Impact of a Public Health Approach to Improving the Physical Health of People Living with Mental Illness. International Journal of Environmental Research and Public Health. 19(18):11746.
Roberts, R., Lockett, H., Bagnall, C., Maylea, C., & Hopwood, M. (2018). Improving the physical health of people living with mental illness in Australia and New Zealand. The Australian Journal of Rural Health, 26(5), 354–362. https://doi.org/10.1111/ajr.12457
Presentation 4: Equally Well: A national review of initiatives to enhance physical health (Implementing the Consensus Statement).
Authors: Lynee English & Russell Roberts
People living with mental illness are denied the right to equality in physical health outcomes, experiencing poorer access and lower quality health care than the rest of the population.1 Structural discrimination and processes such as diagnostic overshadowing are key factors underlying this. 2
Using a multi-format response platform, the project team conducted a national scan of initiatives to improve the physical health and equity of access to healthcare for people living with mental illness. This presentation overviews and summarises the findings of this national review.
The review revealed 169 initiatives underway across the government, NGO, PHN, consumer advocacy, chronic care and professional workforce sectors. The main foci of initiatives were care coordination (n=97 activities), and prevention and early intervention (n = 82). The results indicated that 78% of the initiatives incorporated lived experience expertise in project design and implementation. The review also resulted in 104 consumer, carer and clinician resources submitted for sharing and dissemination.3 These have been curated into a searchable online resource repository.
This review also identified significant gaps in service reform and provides recommendations to address these gaps and to better coordinate activities across the mental health, primary care and chronic care sectors.
Access to quality physical healthcare is a fundamental human right currently denied to people with mental illness. This presentation demonstrates how practical actions can make difference by enhancing equity of access to healthcare and improve physical health outcomes.
People with mental illness are at very high risk of poor health and early death due to preventable chronic physical health conditions.4