Hamilton Centre for Integrated Care of Mental Health and Addiction

The design process for the Hamilton Centre was a comprehensive and collaborative effort aimed at creating an integrated care model that addresses the needs of individuals with co-occurring mental illness and substance use disorders. This process began with extensive co-design consultations, engaging 57 participants from over 40 organisations across Victoria, including mental health (MH) and alcohol-and-other-drugs (AOD) sectors, clinical leaders, peer workers, government officials, and lived experience advocates. This collaborative effort was structured around multiple phases, focused on identifying system-level barriers, training needs, and cultural change initiatives to develop a best practice model for integrated care that supports the new Hamilton Centre.

Sequenced co-design workshops were anchored through the lens of lived experience, through the development of persona narratives that sought to represent MH and AOD service users in Victoria. These personas were co-designed and iterated, in consultation with design practitioners and researchers, and then eventually with co-design workshop participants themselves. This iterative process ensured that the model developed was responsive to the needs identified by stakeholders.

By embedding lived experience at every level of development and operation, the Hamilton Centre’s design process has created a robust, responsive, and inclusive service model that addresses the complex needs of individuals with co-occurring mental health and substance use disorders. The co-design process laid the foundation for the Hamilton Centre’s governance and operational structures, where regular meetings with clinical network partner providers were established to develop the model of care, guidelines, and memorandums of understanding (MOUs) for primary and secondary consultations across the state. Regular feedback meetings with stakeholders - established through the initial co-design process - ensure ongoing refinement, adaptation and growth of the Hamilton Centre and its service model. The co-design process has also guided the development of multimodal, cross-sector education and training, and public digital information dissemination.

The Statewide consultation for the Hamilton Centre engaged 57 stakeholders from 40+ organisations across Victoria to craft an integrated care model for mental illness and addiction. By bringing together AOD and mental health workforces with lived experience advocates, this process sought to design a service with and for people with co-occurring addiction and mental illness. As the Victorian Minister for Mental Health, Hon. Gabrielle Williams MP remarked: “The Hamilton Centre is an important part of an integrated system which will give people the best treatment and recovery.”

The co-design process drew on real-life experiences using consumer and workforce personas (co-created with consumer and clinical expertise) to ground discussion through the lens of lived experience. The initial two workshops responded to Royal Commission (RC) Recommendation 35 for integrated care, focusing on core principles of Inclusion, Access, Capability and Participation. A final workshop brought together the stakeholder community group with leadership staff from across sectors to discuss the process of change toward integrated care.

The current fragmented service system incurs costs for consumers and providers alike, with the RC estimating the economic cost of poor mental health to Victoria as $14.2 billion/year. The Hamilton Centre serves as a flagship within Australia for advancing integrated care, offering direct clinical care alongside training programs, scholarships, mentorship and navigation assistance. In its first year alone, the centre has received over 970 referrals and 218 enrolments in training modules, contributing to reshaping the narrative on how care is provided globally in co-occurring mental health and substance use disorders.

The model is internationally unique, with abstracts submitted to a symposium at the Lisbon Addictions Conference (Oct 2024) and the 2024 conference for the Australasian Professional Society on Alcohol and other Drugs (APSAD), Australasia’s leading multidisciplinary organisation for professionals involved in the drug and alcohol field.

Although integrated care is widely supported to improve treatment outcomes, achieving this across a fragmented service system remains challenging. The co-design process provided an innovative means of enabling trauma-informed collaboration with diverse stakeholders while ensuring that lived experience was embedded in the development and design of the Hamilton Centre.

The extensive co-design consultation process coalesced a stakeholder community to become invested in the ongoing change management required to support integrated care in Victoria. This collaborative effort is ongoing, with feedback being collected through regular meetings with stakeholders across sectors at all sites of the Hamilton Centre.

The process also laid the foundation for the Hamilton Centre’s ongoing commitment to collaboration and the role of lived experience at every level of governance and operations. This includes: Monthly governance meetings with the clinical network partner providers, working collaboratively to develop the model of care, guidelines and MOUs in relation to primary and secondary consultations across the State; outreach to regional mental health services to explore the development of services to meet local needs; collaboration with other Victorian and National MH training providers to cross-promote training opportunities; development of advisory groups to provide input into training initiatives (involving clinical and lived experience); and, the establishment of the Hamilton Centre’s Service Navigation Team that supports and mentors clinicians in integrated care delivery, with service navigation and linkage, information provision, and requests for education or training throughout the state.

The design process continues to inform the development of training, education and service development. The Centre’s training programs, built around the personas validated in the co-design process, address system-level barriers identified through the final workshops. Further, the professional development provided by the 18 month co-design process has supported the Centre’s leadership group to embed co-design methods and mindsets in their ongoing work.

The Hamilton Centre’s initiatives have had a profound impact, strengthening partnerships across its network, expanding staff training, and supporting future healthcare professionals. As a collaborative network, the Hamilton Centre’s specialised addiction services are delivered by St Vincent’s Hospital, Eastern Health, Western Health, Austin Health, and Goulburn Valley Health – playing an important role in guiding best practice.

The Centre has supported over 970 referrals in the first year alone, supporting people previously excluded from the system. Expansion efforts include increasing the number of addiction specialists across health services and extending outreach to regional areas.

Complementing the specialised addiction services, the Hamilton Centre’s multidisciplinary Advice and Mentorship Line is a unique, on-demand service. It aids in navigating complex service systems, offering healthcare professionals tailored peer support and advice and mentorship conversations as a single contact or follow-up as required. This innovative service, part of a circular process, uses ongoing data collection to inform workforce training and clinical support within the addiction service network. It overcomes system barriers related to knowledge access and fosters capacity building in a truly responsive manner.

The Centre’s training programs further impact system-level barriers identified through the final stage of the co-design process. This includes training for co-occurring needs, addressing stigmatising attitudes among staff and consumers, and programs to support organisational cultural change across individual and institutional levels. Education efforts have been praised, with 218 people enrolling in training modules based on personas developed and validated via co-design in the inaugural year. 100% of participants surveyed suggested they would recommend the program to colleagues. Requests from Vocational Education and Training (VET) and university sectors for education underscore the Centre’s influence, embedding integrated care principles into healthcare students’ practice frameworks. This holistic approach fosters improved outcomes for individuals with co-occurring conditions, driving a paradigm shift towards integrated care delivery.