International perspectives on implementation of system change in family mental health.

Introduction: 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 organizations and systems, less is known about how systems change occurs and what supports systems change to improve outcomes for families. Methods: 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. Results: 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. Discussion: 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.