Integrating social health and wellbeing into a system of care

Objective 7.4:

Strengthen integration between services working with Indigenous people

Action 7.4.1:

Strengthen work across services and sectors and between clinical and non-clinical services, including through referral, assessment and joint case management, to ensure holistic, person-centred care that takes into account issues such as transport, housing and income

As part of the PHN’s Primary Mental Health Care and Drug and Alcohol Programs, funding has been provided to the Institute for Urban Indigenous Health (IUIH) to support expansion and enhancement of existing services with a focus on integrating social health services into IUIH’s System of Care[1].  IUIH’s System of Care is informed by a strong Cultural Integrity Framework – known as The Ways[2].

Key Achievements

The expansion of social health services has seen ten additional FTE[3] added to the social health team, comprised of a mix of psychologists, counsellors and social health care coordinators.  These health practitioners work across six Aboriginal and Torres Strait Islander Community Controlled Health Services in the region – in Caboolture, Deception Bay, Margate, Morayfield, Northgate and Strathpine.

The expanded social health team build on the culturally responsive System of Care, supporting integration with the range of holistic primary health care services provided – including general practice, dentistry, optometry, podiatry, dietetics and more.

During 2018/2019, the Social Health team provided outreach support to over 500 Aboriginal and Torres Strait Islander people.

Key Learnings

The Social Health team take a relationship-based approach to health and wellbeing… “Everything we do is based on warm relationships and strong referrals.  We spend time with people, making connections with them and getting to know them.  We make sure that no one walks away without establishing a connection.  Without this strong relationship, we can’t begin to address people’s wellbeing.” (IUIH Social Health team member).

What’s Next?

IUIH’s Social Health team continue to look for innovative ways to reach Aboriginal and Torres Strait Islander people who cannot connect with an Aboriginal and Torres Strait Islander Community Controlled Health Service – including by connecting people to other culturally appropriate practitioners in the community.



[3] FTE – Full Time Equivalent roles

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