Positive mental health as a predictor of recovery from mental illness.

BACKGROUND: High levels of positive mental health protect individuals from mental illness. This study investigates longitudinal change in positive mental health as a predictor of mental illness recovery in a cohort group. METHODS: Using data from the 1995 and 2005 Midlife in the United States cross-sectional surveys (n = 1,723), logistic regression was used to estimate the odds ratio that individuals diagnosed with a mental illness in 1995 would have recovered in 2005 based on whether their level of positive mental health changed over the 10-year period. RESULTS: Individuals who maintained or gained the highest levels of positive mental health were more than 27.6 and 7.4 times, respectively, more likely to recover when compared to those who maintained the lowest level of positive mental health. Those who maintained or gained moderate levels of positive mental health had more moderate likelihood of recovery, and those whose positive mental health declined to the lowest levels had no significantly different likelihood of recovery compared to participants whose positive mental health remained low. LIMITATIONS: This study was limited by the age of the data, and the inability to control for some predictors of recovery. CONCLUSIONS: This study suggests that positive mental health may be an important resource for individuals to recover from mental illness and stay mentally healthy. Results point to the need to include positive mental health assessment and interventions into mental health care systems.

Regional responses to the challenge of delivering integrated care to older people with mental health problems in rural Australia.

OBJECTIVE: Integrated care has been identified as means of managing the demands on the healthcare budget while improving access to and quality of services. It is particularly pertinent to rural health services, which face limited access to specialist and support services. This paper explores the capacity of three rural communities in South Australia to deliver integrated mental health support for older people. METHODS: Thirty-one interviews were conducted with local health and social service providers from mental health, community health, general practice, residential aged care, private practice, NGOs and local government as part of a larger action research project on service integration. RESULTS: Participants highlighted differences in service delivery between the communities related to size of the community and access to services. Three structural barriers to delivery of integrated care were identified. These are as follows: fragmentation of governmental responsibility, the current funding climate, and centralisation and standardisation of service delivery. CONCLUSION: We conclude that despite a focus upon integrated care in mental health policy, many features of current service delivery undermine the flexibility and informal relationships that typically underpin integration in rural communities.

Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: protocol for a mixed methods case study.

INTRODUCTION: An integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated servicing should occur, although interorganisational relations theory suggests a reflective network approach using evaluation feedback. This research will test a network management approach to help regional primary healthcare organisations improve mental health service integration. METHODS AND ANALYSIS: This mixed methods case study in rural South Australia will test facilitated reflection within a network of health and social care services to determine if this leads to improved integration. Engagement of services will occur through a governance group and a series of three 1-day service stakeholder workshops. Facilitated reflection and evaluation feedback will use information from a review of health sector and local operational policies, a network survey about current service links, gaps and enablers and interviews with older people and their carers about their help seeking journeys. Quantitative and qualitative analysis will describe the policy enablers and explore the current and ideal links between services. The facilitated reflection will be developed to maximise engagement of senior management in the governance group and the service staff at the operational level in the workshops. Benefit will be assessed through indicators of improved service coordination, collective ownership of service problems, strengthened partnerships, agreed local protocols and the use of feedback for accountability. ETHICS, BENEFITS AND DISSEMINATION: Ethics approval will deal with the sensitivities of organisational network research where data anonymity is not preserved. The benefit will be the tested utility of a facilitated reflective process for a network of health and social care services to manage linked primary mental healthcare for older people in a rural region. Dissemination will make use of the sectoral networks of the governance group.