'Partnership' is a term that has entered the mental health field in relatively recent times. The term is used frequently in policy documents, increasingly in the professional literature and is heard regularly in the day to day conversations of people involved in some way with mental health care and services. It is a key concept in the development of policy to empower consumers of mental health services and their families and/or carers at both state and federal levels. It is expected that health professionals will adopt a partnership approach in providing mental health care and services.
Policy at all levels recommends a partnership approach to the delivery of mental health care (e.g. Second National Mental Health Plan 1998). There is also a moderate amount of research evidence demonstrating the efficacy of the partnership approach. People with a mental illness and their families and/or carers have the right to expect this approach.
Partnership: Engebretson & Wind-Wardell (1997, p.38) describe partnership as 'a relationship resembling a legal partnership and usually involving close co-operation between parties having specified and joint rights and responsibilities as in a common enterprise'. They add, 'Partners become integral parts of the whole with respect to individual and collective contributions'.
Therapeutic partnership: A partnership, as defined in the context of mental health service delivery, aims to reinforce shared responsibility, accountability and decision making between the person with schizophrenia, their family and/or carers, the mental health worker and the health system. Hamilton-Wilson & Hobbs (1995) describe a 'therapeutic partnership' as one that requires shared power in the entire decision making process. Such a partnership seeks to provide an environment that will support recovery from schizophrenia, empower the person with schizophrenia and their families, and prevent isolation and social marginalisation.
Collaboration: Collaboration in a mental health context refers to individuals, families/carers and mental health workers/services working together toward a shared goal.
Consultation: Consultation is a term that is frequently used in association with partnerships. The definition proposed by Curtis & Meyers (1988, p.36) states consultation 'is a collaborative problem solving process in which two or more consultants and consultees engage in an effort to benefit one or more other persons for whom they bear some level of responsibility within a context of reciprocal interactions'.
Who is involved in partnerships?
The person with a mental illness is a key stakeholder who must be in a position to influence decisions on all aspects of mental health services and be adequately resourced and assisted to do so.
Families and/or carers have an important role in the care of a relative with a mental illness, therefore it is crucial that they be considered partners in the treatment of the illness. A family and /or carer may feel that they are not being fully informed with regard to the person's illness, nor with the treatment that is being given. Not only does this place the family at a disadvantage in attempting support and care, but the mental health workers miss out on the valuable information which can be provided by family members or other carers.
Private psychiatrists and the private mental health sector provide treatment and support for some people with a mental illness. Access to disability and related support services or public mental health services must also be available for people using the private sector.
Emergency services, including police, ambulance officers and staff of emergency departments in general hospitals, who are often the first point of contact for people with a mental illness at times of crisis or acute need.
The wider health sector which through the mainstreaming of mental health services has taken on responsibility for the management and provision of mental health services in all States and Territories. Partnerships in collaboration with maternal and child health, geriatric and paediatric services, public health and health promotion agencies must be pursued by mental health services.
Other government services including the criminal and juvenile justice systems, the welfare sector and drug/alcohol services, many of which are particularly relevant to people with schizophrenia.
Non-government agencies play a vital role in mental health care including broad advocacy and networking (e.g. NSW Association for Mental Health), services specifically for schizophrenia (e.g. Schizophrenia Fellowship NSW) and specific care provisions for people with schizophrenia (e.g. rehabilitation, housing and living skills).
Community support services including housing, home help, recreation, family support, employment and education which are essential elements in improving the quality of life of people with schizophrenia. These services are funded and provided by a wide range of government and non-government organisations and require information, training, support networks and clear linkages with mental health services.
The broader community including employers, service organisations and community leaders who, with increased understanding of mental health issues, can help reduce stigma, encourage timely referral of people in need and provide support to people within their setting.
This section has been adapted from the Second National Mental Health Plan (1998) and Caring for Mental Health: A Framework for Mental Health Care in NSW (1998).
Benefits of a partnership approach
- Partnerships are an effective way to provide services that are responsive to the needs of individuals with schizophrenia and their families (Hamilton-Wilson & Hobbs 1995).
- The process involved appears to have a positive effect on the development of shared responsibility, accountability and decision making (Hamilton-Wilson & Hobbs 1995).
- Partnerships that are collaborative and consultative provide a variety of perspectives, approaches and expertise that can benefit all those in the partnership (Pennebaker 1991). The supportive and collaborative environment of a therapeutic partnership allows goals such as learning to cope with prodromal symptoms and warning signals to be pursued (Boker 1992).
- Some support is present for the positive effect a partnership environment has on improving the emotional atmosphere in a family where a member has schizophrenia (Falloon et al. 1993).
- Partnerships appear to be a useful approach in family intervention where lower levels of expressed emotion (EE) are the desired outcome. (Mintz et al. 1987).
Barriers to partnerships
While the concept of partnership is policy at both state and federal levels, barriers to its implementation still exist. These include:
- issues to do with maturity, ownership and control;
- lack of a cohesive and comprehensive approach to therapy;
- problems associated with hierarchy and unequal distribution of power;
- ideological incompatibilities between partners;
- lack of understanding of the nature of partnerships and how to work effectively in this type of relationship;
- unwillingness on the part of one or more of the partners to engage in reciprocal relationships;
- lack of understanding about the cyclical nature of schizophrenia and its impact on functioning;
- lack of commitment to the concept; and
- the language professionals use to describe and interact with families.
(Engebretson & Wind-Wardell 1997; Welch & Sheridan 1995; McLean 1995; Hatfield 1986)
These barriers are not insurmountable. Rather they need to be taken into account when entering into a partnership relationship in mental health care and revisited from time to time during the life of the relationship.
For a list of references for this quality of life section on partnerships, click here.
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