title: Using participatory action research in a community-based initiative addressing complex mental health needs.
abstract: OBJECTIVE
  This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community.
  
  
  METHODS
  Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions.
  
  
  RESULTS
  Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources.
  
  
  CONCLUSIONS
  The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.
authors.affiliation: Southern Dual Diagnosis Service, Victoria, Australia. stephen.knightbridge@southernhealth.org.au
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Knightbridge
authors.forename: Robert
authors.initials: R
authors.lastname: King
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Rolfe
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003156:Community Mental Health Services; D003256:Community Participation; D003159:Community-Institutional Relations; D006233:Persons with Disabilities; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012107:Research Design; D012931:Social Environment; D012944:Social Support; D011795:Surveys and Questionnaires