Integration in a nurse practitioner-led mental health service in rural Australia

Abstract

Objective: Integration of mental health services is a prominent Australian mental health policy goal; however, there is little detail in the literature of how integrated mental health services are established or function. This study aimed to describe a nurse practitioner-led primary healthcare rural mental health service and evidence of how the service was integrated with other services and the community.

Design: This pragmatic exploratory study used case study methodology and analysed documents, quantitative data and qualitative data from individual and group semi-structured interviews and a 'stakeholder meeting'. The study was part of a formal evaluation of this nurse practitioner service.

Setting: Rural New South Wales.

Participants: Twenty-one service providers and stakeholders.

Interventions: Introduction of a nurse practitioner led mental health service.

Main outcome measures: Not applicable.

Results: Purposely sampled participants were interviewed. Documentary evidence included briefing notes, minutes and progress reports and provided important background information. Non-identifiable aggregated client data were analysed. Thematic analysis of the qualitative data produced a description of how and why the service was established, a description of the service and its impact and three analytic themes providing evidence of integration. Challenges to integrating this service are also discussed.

Conclusions: The service was highly regarded. It addressed the drug and alcohol and mental health needs of a vulnerable rural community. The inception and implementation of the service were community driven, led by a number of agencies supported by a steering committee and underpinned by a Partnership Agreement. The service demonstrated key features of integration alongside experiencing challenges in optimising integration with acute mental health services.

Keywords: mental health service delivery; model of rural health service delivery; nurse practitioner; primary health care; rural service planning.