16/07/2026
When you see genuinely integrated care, it can seem almost magical.
Siloed thinking is so deeply embedded in Western society that we barely notice it. It is simply the way we organise the world.
Every organisation is built on a set of assumptions. Assumptions about what people need. How they behave. What they know. What they can do for themselves. Most of those assumptions are never written down. Yet they shape everything, from organisational structures to funding models, professional roles and the experience of the people we exist to serve.
Look around at business. Shoe shops sell shoes. Fast food outlets sell fast food. Banks provide banking. Pharmacies dispense medicines. Even the corner "to***co" shop has often diversified into fast food (for reasons we all understand) but it is still built around a single commercial purpose.
This model works because it rests on a series of mostly accurate assumptions:
People have money.
People have transport.
People know they need shoes and they know where to find them.
People have the time, confidence and capacity to seek shoes out.
Now imagine a different world.
Imagine opening a shoe shop where your customers have no money, no car, and often don't realise they need shoes. If they do realise, they don't necessarily know where to find them. Some struggle to plan ahead. Some find it difficult to trust strangers. Some cannot navigate the systems designed to help them.
Would you still build a traditional shoe shop in this parallel universe?
Of course not.
You would rethink almost every aspect of the business. You might take the shoes to people. You might combine shoes with other essential supports. You might actively find customers rather than waiting for them to arrive.
Health, mental health, alcohol and other drug, legal and community services are not quite as siloed as the shoe shop analogy suggests, but historically they are not far off.
For decades we have organised services around disciplines, funding streams and professional identities. General practice here. Mental health there. Alcohol and other drug services somewhere else. Housing in another building. Legal assistance a few suburbs away. And none of those people communicating with each other.
Each service has understandable reasons for existing independently. Yet collectively we often expect the person experiencing the greatest disadvantage to do the work of integrating them.
Again, this isn't because these organisations are poorly designed. Many are exceptionally well designed. But they are not designed for people with complex, co-occurring needs and these are the people that need them the most.
Governments now routinely speak about integration, collaboration and person-centred care. Almost everyone agrees these are worthwhile ambitions. Yet remarkably few organisations genuinely attempt them. I suspect that's because integration isn't primarily an organisational challenge.
It's an assumptions challenge.
As long as we assume people can navigate fragmented systems, remember appointments, coordinate multiple providers, understand the relationship between their health, housing, legal and financial challenges, and advocate for themselves when things go wrong, siloed services make perfect sense.
And even if we know that these assumptions are not correct, the inertia towards siloes, and the lack of guidance around how to overcome them, prevails.
So, here's a little guidance. Not rocket science at all, but more like common sense.
Integrated care is all the help you want and need, from one team, in one place.
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No organisation achieves that perfectly. We certainly don't. But if your purpose is to support people experiencing complex, co-occurring needs, including mental illness, substance use, homelessness or entrenched poverty, then this is a useful place to begin.
Start with different assumptions, then, as an organisation, have the courage to follow the accurate assumptions to their logical conclusions. I am speaking here both to people making strategic decisions about their organisations, but also to the funders.
If you back accurate, evidence-based, modern non-siloed understandings of people with co-occurring needs, a logical approach will emerge pretty quickly.
You'll probably want your peopel to see general practitioners, and general practitioners who understand addiction medicine. You'll probably want nurses working alongside those GPs.
You'll probably want mental health nurses, psychologists and psychiatrists as part of the same team, but mental distress and substance use have the same origins, and are causal and compounding.
You'll probably want lawyers, because legal problems are often health problems in disguise.
You'll definitely want peers with lived experience to provide uniquely relatable insights and support.
You'll need care coordination, shared information systems, multidisciplinary discussions, continuous learning, evaluation, and leadership that values collaboration as highly as technical expertise.
Without really noticing it, you've stopped designing services around professions and started designing them around people's lives.
Look closely enough and something interesting happens.
You haven't simply integrated existing services.
You've begun to build an entirely different kind of organisation.
At First Step, that's what we've been trying to do for two decades. Not because we set out to create a new model, but because the realities of the people we exist to support gradually challenged almost every assumption on which we ourselves had been founded.
I suspect many organisations would arrive at similar models if they started from the same place.
The real magic is not integration itself. It is listening long enough and deeply enough, to the people you are trying to support. When we allow their lived reality, rather than our organisational structures, to shape our assumptions, new understandings emerge. And from those new understandings comes a fundamentally different way of working together.
