The crisis in mental health: the chariot needs one horseman

To the Editor: The recent editorial by Andrews1 quotes a report suggesting that the integration projects funded by the Australian Government produced substantial benefits to patient care at no extra cost. Working in an area in which one of these projects was funded, I suggest that such an inference is unwarranted, particularly as many patients report increased difficulty in accessing public mental health services.

The Illawarra, being geographically circumscribed and with a relatively small medical population, has always had a high degree of interaction between services, although it is true to say that these have somewhat declined in recent years with larger bureaucracies and increased privacy concerns. In my early days in the area, there was a monthly meeting involving police, Youth and Community Services, the Housing Commission, school counsellors, and hospital and community social and mental health workers to coordinate the management of problem families. Sadly, this no longer occurs.

Unfortunately, the major effect of the integration project was simply to add a management structure to the prior interaction, and not to significantly increase it. It seemed that the core issue was control and not service provision. Useful coordination projects, such as some commonality of core records, never seemed to happen, and with the passing of the project, things have, in fact, been worse, as fundamental community services such as the crisis team and chronic care components have been cut.

I have always been a strong supporter of a more integrated approach to care, but one that does not grow primarily from the workers involved in day-to-day clinical care and that addresses their needs is unlikely to be lasting and successful.