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The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The main interest focuses on community stakeholders’ perception of their problems and solutions that communities can create to achieve better mental health coverage.

A series of roundtables (RTs) (4 RTs, 62 participants overall), accompanied by interactive brainstorming techniques, were conducted with communities’ representatives/stakeholders from the East of Ukraine (Lugansk region, a government-controlled area) during the year 2021. Participants (health, mental health, social care workers and administration representatives) were provided with the opportunity to discuss mental health services’ development challenges and create affordable solutions for their communities. Results of discussions were submitted to qualitative analysis and offered for review by participants.

Decentralisation in Ukraine led to allocating funds alongside responsibilities for developing the services to communities. Most of the communities appear not to be ready to acknowledge the role of mental health services, entirely relying on the existing weak psychiatric hospital-based system. Awareness-raising interactive capacity-building activities for the community leaders and decision-makers effectively promote community-based mental health services development. Five clusters of challenges were identified: leadership, coordination and collaboration problems; infrastructure, physical accessibility and financial problems; mental health and primary health-care workforce shortage and lack of competencies; low awareness of mental health and available services and high stigma; war, crises and pandemic-related problems. Communities stakeholders foresaw seven domains of action: increasing the role of communities and service users in the initiatives of governmental bodies; establishing in the communities local coordination/working groups dedicated to mental health service development; developing the community-based spaces (hubs) for integrated services provision; embedding the mental health services in the existing services (social, administrative and health care); mental health advocacy and lobbying led by local leaders and service users; increasing capacity of communities in financial management, fundraising; developing services by combining efforts and budgets of neighbouring communities.

The study has potential limitations. Participants of the roundtables were mostly appointed by local authorities, so some of them didn`t have a motivation for mental health services development. Service users were involved only from the facilitators` side, not from the side of communities; therefore, it was impossible to include their view of problems and solutions. Obtained data were limited to the opinion of local professionals, administration workers and other local stakeholders. The human rights aspect was not clearly articulated in the tasks of the roundtables.

To the best of the authors’ knowledge, the paper is original in terms of its topic (connecting decentralisation and local stakeholders’ engagement for understanding the challenges of mental health services development) and research strategy (engagement of Ukrainian communities, qualitative analysis of the discussion results and applying the best practices and international recommendations to the local context).

Integration is a watchword in Government policy, designed to give more seamless, and therefore more effective, services to people in need. One concern, though, is that this is merely a ‘structural’ approach that just rearranges the deckchairs. This paper gives a practical example of a positive, local leadership approach to integration within a national context.

Chronic illnesses require long term, ongoing medical care as well as the provision of a variety of social support services. These diverse systems of care need to be integrated. However, under managed care, health care systems adhere to a disease model where emphasis is placed upon cure rather than care. While managed care can increase system coordination, the logic of cost containment favors acute services over the long term supportive services needed by chronic care clients. In this paper I describe efforts in one community which has received funding to integrate services for individuals with chronic mental illness as well as a planning grant to integrate multiple chronic care systems (HIV, mental health, and substance abuse) for minority clients. I describe various models of system integration and how diverse systems can be coordinated. In the conclusion I examine the barriers to system integration and argue that sociologists need to play a stronger role in understanding systems of care.

Health service organizations and professionals are under increasing pressure to work together to deliver integrated patient care. A common understanding of integration strategies may facilitate the delivery of integrated care across inter‐organizational and inter‐professional boundaries. This paper aims to build a framework for exploring and potentially aligning multiple stakeholder perspectives of systems integration.

The authors draw from the literature on shared mental models, strategic management and change, framing, stakeholder management, and systems theory to develop a new construct, Mental Models of Integrated Care (MMIC), which consists of three types of mental models, i.e. integration‐task, system‐role, and integration‐belief.

The MMIC construct encompasses many of the known barriers and enablers to integrating care while also providing a comprehensive, theory‐based framework of psychological factors that may influence inter‐organizational and inter‐professional relations. While the existing literature on integration focuses on optimizing structures and processes, the MMIC construct emphasizes the convergence and divergence of stakeholders' knowledge and beliefs, and how these underlying cognitions influence interactions (or lack thereof) across the continuum of care.

MMIC may help to: explain what differentiates effective from ineffective integration initiatives; determine system readiness to integrate; diagnose integration problems; and develop interventions for enhancing integrative processes and ultimately the delivery of integrated care.

Global interest and ongoing challenges in integrating care underline the need for research on the mental models that characterize the behaviors of actors within health systems; the proposed framework offers a starting point for applying a cognitive perspective to health systems integration.

New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices.

This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively.

The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services.

Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.

To understand how people using community public mental health services conceptualize community and their place within it within the post-deinstitutionalization era.

Two hundred ninety-four service users completed structured interviews in two urban, outpatient, public, and community mental health facilities in the Northeast. Quantitative and qualitative responses to the MacArthur Scale of Subjective Social Status, Community Ladder version, were analyzed to understand perspectives on community.

Mean subjective community status ladder score among participants was five (SD = 2.56). Participants identified four broad categories of definitions of community: geographic community; community related to social definitions; contributing to society; and mental health service-user communities. Explanations for the location of their placement on the ladder (subjective community status) include comparisons to self and others, contributions to community, and social relationships. There was also a set of explanations that spoke to the intersection of multiple marginalizations and structural constraints. Finally, we explore relationships among understandings of community and perceptions of place within community.

Community integration is a critical concept for community public mental health services, but little research has explored how mental health service users conceptualize their communities and their roles within them. Understandings of community are crucial to appropriately support peoples’ needs within their communities. Furthermore, participants identify mechanisms that facilitate their personal community standing, and these are areas for potential intervention.

Severe mental illness affects a significant number of people and, if left untreated, leads to poor quality of life and disability. Many of the aspirations proposed for new models of care assert that better preventative services, closer integration between professionals, and increased access to cognitive behavioural therapy in primary care will bring substantial benefits and improved outcomes. The purpose of this paper is to explore the benefits of integrating mental health services into primary care, and improving collaboration between secondary services and primary care. There is a transition underway in healthcare whereby a focus on illness is being supplemented with, or refocused towards achieving better patient well-being. New approaches to service provision are being proposed that: focuses on more holistic outcomes; integrates services around the user; and employs innovative system techniques to incentivise professional and organisational collaboration. Such a transition must be inclusive of those with mental health needs managed in primary care and for those people with serious mental illness in secondary care.

This paper discusses the issues of professional collaboration and the need to provide mental healthcare in a continuous and coordinated manner and; how this may improve timely access to treatment, early diagnosis and intervention. Importantly, it is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit of better integrating mental health into a more collaborative system may lie.

Identifying and addressing issues of parity is likely to call for a new approach to service provision that: focuses on outcomes; co-designs services integrated around the user; and employs innovative contracting techniques to incentivise provider integration.

There is a transition underway in healthcare whereby a focus on illness is being supplemented with or refocused towards working towards wellness. Such a transition requires primary care mental health services to be provided in a continuous and coordinated manner in order to meet the health needs of people with serious mental illness.

It discusses the issues of professional collaboration and how this may improve timely access to treatment, early diagnosis and intervention. It is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit may lie.

The integration of peer support workers with lived experience of mental health problems into existing mental health services has been found beneficial in some ways. However, some peer support workers have experienced unique challenges in terms of role confusion and limited opportunities for networking and support. Qualitative research and evaluation regarding peer support worker integration is limited. This paper aims to address this issue.

The current paper presents a qualitative evaluation of the experiences of two peer support specialist (PSS) workers and their managers within one UK mental health trust. The PSS workers and managers were interviewed individually using a semi‐structured format. Thematic analysis was applied to the interview transcripts.

In agreement with prior research and evaluation, positive experiences and challenges were identified in relation to PSS employment, both for PSS workers and their teams. Overarching themes concern the PSS worker as “other”, the PSS worker as a “change agent”, and “readiness for PSS worker employment”.

The evaluation is limited by the small sample size but the findings could be used to inform the integration of PSS workers into other existing services. This evaluation begins to untangle some of the tensions around the integration process. Strategies to support PSS integration based on the recommendations of participants and the findings of the current evaluation are presented.

Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services.

The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets.

In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services.

Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners.

This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID.