How can we manage primary care networks: Mixed Methods Case Study in Rural Community Mental Health Care for Older People

Context: Older people's mental health crosses primary, mental health and social care sectors that in Australia are fragmented. Primary care networks are ideal when needs cross sectors, but they require facilitative management to build trust and reciprocity. Objective: Test the feasibility of facilitated network reflection as a management process to engage services in problem-solving older people’s primary mental health care. Design: Participatory mixed methods case study using organisational social network analysis, key informant interviews and policy review fed back through a governance group and stakeholder workshops. Intervention: Model of facilitated network reflection using network theory and methods. Setting: Mental health, primary and social care services located in southern rural South Australia. Participants: Thirty two staff from 24 services and 12 senior service managers. Results: Health and social care organisations saw that they operated in clustered, separate, self-managed networks & within rather than across sectors, with no overarching purposive older people’s mental health care network. Facilitated reflection revealed service goal and role conflicts, but this helped local services to identify as a network and begin problem-solving communication and referral links. Barriers to integrated servicing through a network included the lack of a clear network administration organisation leading to a leadership hiatus and service funding tied to performance of direct care tasks. Conclusion: Facilitated reflection helped organisations identify as a network, but revealed some sensitivity about organisational roles, which demonstrated that conflict should be expected as a part of the network manager’s role. Networked servicing needed a neutral network administration organisation with cross sector credibility, a mandate and with the resources to monitor the network, deal with conflict, negotiate commitment amongst service managers and provide opportunities for different sectors to meet and problem-solve. This requires consistency & sustained inter-sector policies that include strategies and funding to support health and social care network management.