Hub and spokes in intellectual disability mental health support

Abstract

Purpose The distribution of specialist health services is usually uneven by location due to limited resources, which is a problem for people with complex needs. In this context, the research addressed the question: How can a hub and spoke model offer appropriate (available, accessible, acceptable and quality) services for people with intellectual disability and mental health needs? Methods The research applied the question to point-in-time qualitative interview data about services for people with intellectual disability and mental health needs in the Australian state of New South Wales (NSW). The interview data were from a larger mixed-methods evaluation of a time-limited intervention (2018-2020). Purposeful sampling was used to recruit 25 program consumers, families and service providers for semi-structured qualitative interviews, and 14 other stakeholders for focus groups and interviews. Topics included their experience of the process and outcomes of the intervention. Data were analyzed against a hub-and-spoke model analytical framework. Results The research found that the appropriateness of health services benefited from funded, local positions. These local professionals liaised between local mental health, health and disability providers. They also liaised with other local areas and with centralized, specialist intellectual disability mental health services. Conclusions The implication is that specific local positions can work as a bridge between generic and specialist services to improve the availability, access, acceptability and quality of services for people with specific support needs. This program worked well in a geographically large area with a scattered population and decentralized health system.