Table 5.

Structural and organisational challenges

Subtheme	Representative Quotes
Difficulties negotiating decision making processes	• I’m not totally across all the bureaucracy yet and the unwieldy bureaucracy is one of the difficulties (Consumer rep)
Difficulty accessing and using resources efficiently	• I think the use of information technology and the form of databases is as much an obstacle as an asset…nothing is purpose built (NBMML Staff). • We need a direct line to Housing, we need a direct line to Centrelink – we’re sitting for 45 min on the phone (NBMML Manager).
No overriding direction	• It’s been really difficult because you don’t have any guidelines. We don’t have any – this is what we’re doing and this is the way it should be (NBMML Staff).
A need for education, training and support	• When we were having problems with our local mental health service, it was evident that education hadn’t filtered down to the ground level, and that’s why we’re getting so much resistance (Support Facilitator). • …within the co-location program. We’re training Centrelink staff in first-aid and how to work with people with a mental illness (NBMML Staff).
Revert to default positions	• I think they [Clinical Services] see us as possibly a threat in some way, or it’s harder for them to change their mindset, being so clinically focused (Support Facilitator).
Risk Aversion	• It’s [PIR] seen as something really alien and different and Medicare Locals in health related coordination are very risk averse about change (NBMML Staff).
Need for long term approaches	• I think it’s a ridiculous concept that the government would think they can get outcomes that quickly for people that are in need, and I hate using this term, but this is people, in the too hard basket, these are the most unwell people that we have in our community (Consortium Manager).