Hamilton Centre: Integrated Care for Co-Occurring Addiction and Mental Illness

The vast majority of people living with a substance use disorder also experience co-occurring mental illness. Treating both concurrently presents a challenge for both consumers and care providers, with the limitations of separate service systems recognised in the 2021 Royal Commission on Victoria’s Mental Health System. This highlighted the pressing need for reform to achieve integrated service delivery for this vulnerable cohort. The design challenge was to support the establishment of a statewide specialist service to address the complexities of fragmented systems, addressing the unique needs of individuals with co-occurring disorders, and improving the quality, timeliness, and continuity of care.

The Hamilton Centre is Victoria’s statewide service for people living with mental illness and substance use or addiction. The centre’s co-design consultation brought together 57 participants from 40+ organisations across mental health (MH) and alcohol-and-other-drugs (AOD) sectors to develop a best practice model for integrated care that supported the establishment of the centre. The process identified: system-level barriers to the delivery of integrated care, specific training needed, and initiatives supporting cultural change. The Hamilton Centre’s specialised addiction services are delivered by a network of reputable public hospitals: St Vincent’s Hospital, Eastern Health, Western Health, Austin Health, and Goulburn Valley Health.

Fragmentation of care for mental illness and addiction remains a legacy of deinstitutionalisation worldwide. The Hamilton Centre stands out as a flagship service, supporting integrated care across sectors. Established in April 2023, it has expanded rapidly, providing a wide range of services, educational and research initiatives. With more than 793 referrals and 127 enrolments in training modules in its inaugural year, the centre continues to expand into the future. This transformative integrated care model is leading Australian service delivery in co-occurring mental health and substance use disorders, marking a crucial step towards more comprehensive care for those in need.

- The integrated care model underpinning the Hamilton Centre was co-designed through iterative workshops, engaging 57 participants for ongoing consultation, including mental health practitioners, AOD practitioners, clinical leaders, peer workers, government officials and lived experience advocates. - More than 40 organisations participated, representing metropolitan services (e.g. Austin Health, Eastern Health, Western Health, St Vincent’s Hospital); regional and rural services (e.g. Albury Wodonga Health, Ballarat Community Health, Bendigo Community Health); community health (e.g. North Richmond Community Health, Odyssey House Victoria); advocacy and support organisations (e.g. Mental Health Victoria, Self Help Addiction Resource Centre); Royal Colleges (e.g. Royal ANZ College of Psychiatry; and, Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and State Government. - The extensive co-design process devised strategies to guide the Hamilton Centre’s ongoing work, supporting change management and training and education programs. - A co-designed series of personas reflected the diversity of consumers in the Victorian Mental Health system. Personas were built upon themes identified by the Victorian Royal Commission, guided by a strength-based and trauma-informed design approach, and validated by clinical and lived experience experts. They continue to support the work of the Hamilton Centre to ground their training programs through the lens of lived experience.