Pablo NICAISE Pr. V. LORANT Pr. V. DUBOIS Institute of Health & Society - UCL

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Jody Summers
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1 Mental health and Social Services Collaboration Social ln Network ka Analysis of Inter-Organisational Partnerships in Brussels Pablo NICAISE Pr. V. LORANT Pr. V. DUBOIS of - UCL

2 Background Issues on the organisation of mental health care Deinstitutionalisation (Inpatient psychiatric units outpatient services) Fragmentation of Mental Health and Social Care Especially in Belgium, fragmentation of (Mental) Health policies Complexity of the field: co-occurrences of mental health and social problems, continuity of care with chronic problems Socially marginalised groups twice more likely to have mental disorders Policy makers ask for partnership working, integration, coordination of care and networking

Complexity of the field: co-occurrences of mental health and social problems, continuity of care with chronic problems Socially

3 Background PROMO, best practice in promoting mental health in socially marginalised people in Europe (EC DG Sanco) How to organise mental well-being promotion and mental health care for socially deprived people? 14 European cities, and 2 deprived areas in each city 6 target groups: long-term unemployed, sex workers, homeless, illegal migrants/asylum seekers, refugees, travellers (Roms) In Brussels: Schaerbeek-St Josse and Molenbeek F2F interviews - Mental Health services, social target group specific services, community general health services ( maisons médicales ), outpatient and emergency services of general hospitals, and CPAS (data collection: 09/08-06/09) Networking data: routine meetings between services, and referrals

14 European cities, and 2 deprived areas in each city 6 target groups: long-term unemployed, sex workers, homeless, illegal migrants/asylum seekers, refugees, travellers (Roms) In

4 Hypotheses Public Health approach: Four models of connectivity (applied to mental health and social care) (Leutz, 1999) Market: users choices Linkage: direct partnership working between MH & SC Coordination: network with broker gateway/management g Fullintegration Inter-organisational networks tend to pursue either breadth large networks of weakly connected services from different sectors or depth small networks of strongly connected similar services (Peck, 2002) The connectivity between social and mental health services is dependant of brokers, that is specific services bridging the two sectors, these brokers possibly have a great influence on network management

large networks of weakly connected services from different sectors or depth small networks of strongly connected similar services (Peck, 2002) The connectivity between

5 Method Social Network Analysis, main concepts Social Network Analysis (SNA) origin in sociograms (Moreno) The main goal of SNA is detecting and interpreting patterns of social ties among actors Graph visualisation and computation of indices Cohesion: Degrees (in a directed graph, in-degree and out-degree) Centrality and brokerage: Closeness and betweenness Sub-groups: Cliques and components

Graph visualisation and computation of indices Cohesion: Degrees (in a directed graph, in-degree

6 Results: Schaerbeek-St St Josse Number of selected services: 43 Number of responding services: 38 Number of mentioned services outside the area: 84 TOTAL number of vertices: 127 In-area Group specific MH services 0 3 Mental Health services Social General Health services + Emergency Group specific social services Out-area Long-term unemployed 7 8 Homeless 2 2 Sex workers 2 3 Refugees 3 8 Drug addicts 3 2 Generic social services 2 12 Other 0 3 TOTAL 43 84

services 13 17 Social General Health services + Emergency 11 11 Group specific social services 17 35 Out-area

7 Results Mental Health Schaerbeek-St & Social St Josse Services All relations Collaboration Degree centrality

8 Schaerbeek-St St Josse All relations Degree centrality Normalised degrees per sector 0,16 0,14 0,12 0,1 0,08 0,06 0,04 0,02 Mean: Median: Min: Max: CPAS SSM HP SOC GH MH Nrmdeg Min Max CPAS SSM HP SOC GH MH

1468 0 CPAS SSM HP SOC GH MH Nrmdeg Min Max CPAS 0.1012 0.0714 0.1310 SSM 0.0886 0.0198 0.

9 Results Mental Health Schaerbeek-St & Social St Services Josse Referrals Collaboration Cliques and components

10 Results Mental Health Schaerbeek-St & Social St Services Josse Referrals Collaboration Betweenness centrality

11 Discussion Intermediary results (in progress) Need for data on other areas / countries to determine patterns Low quality of data, need for specific data collection However, tend to confirm and deepen our hypotheses : Several deep networks (similar services) weakly interconnected CPAS and some general health services (MM) in broker positions between MH and group specific social care Within the MH field, high centrality for some psychiatric hospitals and MHServices Public health expectations: no integrated services, weak direct linkage, services in broker position not commissioned for co-ordination ordination / management of the networks Methodologically, SNA seems powerful to draw and analyse networks

and group specific social care Within the MH field, high centrality for some psychiatric hospitals and MHServices Public health expectations: no integrated services, weak direct

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