International perspectives on system change

Melinda Jane Goodyear^1,2*Becca Allchin^1,3Bjorg Eva Skogvy⁴Anne Grant⁵Kristin Stavnes⁶Bente Weimand^7,8Sophie Isobel⁹Kathleen Biebel¹⁰Joanne Nicholson¹¹Scott Yates¹²Rochelle Hine¹Lina Gatsou¹²Bitta Soderblom¹³Karin van Doesum¹⁴Adrian Farrel Falkov¹⁵Ron Shor¹⁶Juliet Collins¹Clemens Hosman¹⁴Stella Laletas¹⁷

• ¹School of Rural Health, Monash University, Melbourne, Australia
• ²Emerging Minds, Stepney, Australia
• ³Eastern Health, Box Hill, Australia
• ⁴Nordlandsforskning, Bodø, Norway
• ⁵Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, United Kingdom
• ⁶Nordlandssykehuset Bodo, Bodø, Norway
• ⁷Akershus Universitetssykehus HF, Lørenskog, Norway
• ⁸Universitetet i Sorost-Norge Biblioteket Drammen, Drammen, Norway
• ⁹The University of Sydney, Sydney, Australia
• ¹⁰Massachusetts Rehabilitation Commission, Boston, United States
• ¹¹Brandeis University Heller School for Social Policy and Management, Waltham, United States
• ¹²De Montfort University, Leicester, United Kingdom
• ¹³Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
• ¹⁴Radboud Universiteit, Nijmegen, Netherlands
• ¹⁵The Willoughby Clinic,, Willoughby, Australia
• ¹⁶Paul Baerwald School of Social Work and Social Welfare, Jerusalem, Israel
• ¹⁷Faculty of Education, Monash University, Melbourne, Australia

Parental mental illness is a major public health issue across the globe with well-known intergenerational impacts on children. There is a wide body of evidence supporting the effectiveness of a range of interventions supporting families, however, their implementation has rarely been sustained across public health systems. Systemic change is an important part of workforce development and known to be crucial to embed and sustain practice, policy and structural initiatives in services for families. While much is known about the barriers to implementing family focused approaches within organisations and systems, less is known about how systems change occurs and what supports systems change to improve outcomes for families. This study uses a Delphi method, with 103 experts from 17 countries participating to identify systems change factors from their own experience and to build consensus about key strategies required across the globe to support systems change in health, education, social welfare and mental health services. The findings identify that systems change can be defined as any workforce, policy, legislation or other mental health promotion strategy that collectively contributes to improving outcomes for parents with mental illness, their children and their families. A systems approach to improve outcomes for families where a parent has a mental illness requires partnerships and collaboration between services and sectors affecting families (mental health, welfare, primary health, education, social care, public health), social and health policy development, and families themselves. Success in system change requires a focus on change at all levels of the system for momentum building, leadership support, the use of relevant data and reporting mechanisms, establishing practice competency and collaborative care, and being able to reflect and adapt to changing conditions and structural barriers. A focus on system change for supporting families where a parent has a mental illness appears to require the combination of many strategies and factors, with international approaches to knowledge sharing imperative to support implementing, resourcing and sustaining change.