There is increasing recognition that interdisciplinary mental health care can often lead to better outcomes for consumers than care which is provided by individual professionals working in relative isolation in private rooms [1, 2]. The two underlying elements of collaborative care are the construction of collective action as a method of meeting complex client needs and the integration of different professional perspectives that promote relationships which are respectful and trusting . However, collaborative interdisciplinary teams are not common in Australian primary health care, and collaborative care is made difficult by boundaries between professionals and within health services . Understanding of the complexity of relationships between health professionals is limited .
Establishing the kind of relationships necessary to underpin such collaborative care can be difficult, and sustaining them can be even harder . Maintenance of these relationships can be promoted at the individual (e.g., education to promote individual change in behaviour), organizational (e.g., leadership, program champions), community action (which creates new partnerships) and system levels . Often, co-ordinated leadership and external support are needed . The current paper describes an Australian initiative known as the Mental Health Professionals Network (MHPN) that is fostering a collaborative clinical approach to the provision of mental health care by promoting interdisciplinary communication and networking between psychiatrists, general practitioners (GPs), psychologists, mental health nurses, social workers, paediatricians and occupational therapists, with the ultimate aim of improving consumer outcomes.
MHPN is funded by the Australian Government’s Department of Health and Ageing and began operating in August 2008. MHPN rolled out a series of workshops across Australia that were facilitated by one local mental health professional (most commonly a psychologist) and attended by a mixed group of other mental health professionals from the same geographical area. These workshops were supported by a range of educational materials, a website and web portal (MHPN Online) and a toll-free telephone information line. Through informal networking and the presentation of case studies, the workshops aimed to enhance understanding of how and what each profession contributes to the care of the consumer and to improve mental health professionals’ skills in supporting people with mental illness . By July 2010, MHPN had successfully run 1,156 workshops, which were attended by 11,930 mental health professionals [8, 9].
The workshops also aimed to generate interdisciplinary networks, defined as “groups of local mental health professionals around the country who meet regularly to network and discuss mental health issues and thus facilitate improvements in the collaborative delivery of mental health care” . Unpaid volunteer network co-ordinators guide the directions of the network and attend to logistical tasks associated with organising meetings. MHPN staff provide administrative support and guidance to the network co-ordinators. MHPN also makes $500 available per network per annum to assist with network maintenance. MHPN Online supports ongoing networking and interdisciplinary collaboration through a members search function, a networks search function, clinical and general discussion forums, a mailbox that allows MHPN Online members to communicate through personalised emails, event organisation tools, and help pages.
By July 2010, 938 of the 1,156 workshops (81%) had individually or jointly formed a total of 705 ongoing networks [8–10]. The sustainability of these interdisciplinary networks increasingly became a focus of MHPN activities throughout 2009 and 2010. It became apparent that more efforts and resources needed to be invested to ensure the continuity of these networks.
Looking at the sustainability of any program is important [11–15]. Although new programs are often based on the assumption that if they meet an identified need and prove to be effective they will continue to exist, this is not always the case. Many new programs are not sustained beyond the first few years after termination of initial funding , and this can diminish community support for new programs following past patterns of program funding withdrawal . Within this evaluation of MHPN network sustainability, ‘sustainability’ was defined as a multidimensional concept of program continuation which can be considered in relation to components such as project design and implementation, the host organization and the wider community context, as outlined in the literature [13, 14]. Project design and implementation factors include program financing and resourcing, as well as program flexibility, communication of successes and evaluation . Organizational factors which influence sustainability include structure, program champions and integration with existing programs, and wider community factors influencing sustainability such as community support . The process of sustainability includes the concepts of time and permanence but does not limit these concepts. That is, sustainability does not impose timeframes on stages or processes. Our definition of sustainability also does not infer a static program; rather, it suggests an adaptable and fluid program where successful elements are developed and less successful elements reworked . This adaptability is particularly important within the large scale nature of the MHPN initiative, which was evolving over time.
We were commissioned to conduct an evaluation of MHPN that explicitly considered network sustainability. The evaluation is reported in full elsewhere [8, 9]. The MHPN evaluation timeframe required that the evaluation of network sustainability occur at a time-point two years after the beginning of MHPN’s activities. While a later evaluation would be needed to establish whether the interdisciplinary networks formed at the time of the evaluation were sustainable in the longer-term (for example, several years beyond their inception), our evaluation focused on those networks that had already formed and who had continued to meet for the purpose of interdisciplinary collaboration beyond an initial meeting. This paper focuses on issues deemed by MHPN staff and participants as important in affecting the formation and continuation of networks that had continued to meet on a regular basis for the purpose of interdisciplinary collaboration.