Table 3.

Barriers to mental health service integration at Floresco

Barriers/challenges	Stakeholders mentioned …
Bringing staff from four different NGOs together to work as one team	• Differences in organisational culture (values, philosophy, tolerance of risk) • Differences in organisational policies, procedures and practices • Having to negotiate over seemingly minor issues • Challenges — for Aftercare, NGO partners, and staff themselves — related to staff supervision
Barriers to integrating with the MHS	• The fact that this initiative was driven by NGOs, rather than mandated by government • Systemic constraints on the MHS’s ability to participate
Barriers to systematic information sharing	• System barriers preventing NGOs from accessing the MHS information system • Practical difficulties preventing MHS staff from using Floresco’s information system • Differing views among the partner NGOs about the importance of record-keeping • Co-located services not using the shared client information system • Difficulty of ensuring that users of the shared client information system enter data correctly and consistently
Resourcing challenges	• Insufficient NGO funding to support necessary components of the service model • Insufficient NGO funding to enable employment of more appropriately qualified, skilled and/or experienced staff to respond to clinical need • Insufficient MHS resources to enable co-location of staff at Floresco
Staffing problems	• High staff turnover, particularly among support workers • Difficulties in recruiting suitable NGO staff, both support workers and managers • Long delays in filling support worker positions • Difficulties maintaining commitment to the integration vision in the context of management changes • Mental health workforce recruitment difficulties in the Ipswich area
Recruiting and retaining GPs and private mental health practitioners	• Constraints on charging a fee • Lack of incentives and support for private practitioners
Responding to demand	• Higher-than-expected demand for services • Insufficient resources to meet demand
Responding to clinical need	• Higher level of clinical need than expected • Inability to meet demand for private practitioners • Insufficient capability among support workers to respond to clinical need
Operating as a consortium	• Additional and more complex staff management problems for Aftercare • Ongoing clinical governance problems • Lack of benefits for clients • Unequal partnerships • Tension between the need to collaborate in the Floresco service model and the pressure to compete in the context of the incoming National Disability Insurance Scheme
Inconsistent leadership and governance	• Over-reliance on the commitment of key personalities • Difficulties maintaining the commitment to collaboration in the face of several management staff changes, particularly within Aftercare • Inconsistent commitment to the Governance Committee among consortium partners • Uncertainty about an appropriate governance model • Lack of strategic focus by the Governance Committee