Welcome to a new feature at Croakey.

The Primary Health Care Research and Information Service (better known as PHC RIS) is to provide a regular article profiling an item from its weekly bulletin.

The first article ties in neatly with the current Croakey series on mental health reform, looking at shared care models for adults with severe and persistent disorders.

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Shared care in mental illness 

Olga Anikeeva, Research Associate at PHC RIS, writes:

A rapid review conducted by Kelly et al (2011)  sought to address the lack of best practice guidelines for the development and implementation of shared care models for mental health consumers.

In order to improve detection, treatment and outcomes for mental disorders, service models that integrate mental health care with primary health care are necessary.

However, models of shared care are currently poorly defined and can include transfer of care from provider to provider, involvement of one or more services in patient care, or formal cross-service arrangements.

Thus, the aim of the review was to determine whether shared care arrangements result in improved clinical outcomes and to identify the critical components of an effective shared care model. The focus of the review was primarily on adults with severe and persistent mental disorders.

The authors found that models of shared care that incorporate primary health services and specialist mental health care can lead to improvements in clinical outcomes, particularly among individuals with depression and anxiety disorders. They also found some evidence for reduced relapse rates among individuals with psychoses and related disorders.

While the literature that the authors examined used inconsistent definitions of shared care, there were a number of core components that were identified as being important for an effective model.

These include a systematic approach to the engagement of primary and specialist services, a coherent treatment model and agreed clinical pathway, attention to staffing requirements and a well-established clinical governance framework. The provision of a care coordinator who can act as a link between primary care and specialist services was another important element.

The strategies proposed in this review pose substantial challenges related to the translation of evidence into clinical practice, such as the need to change clinician behaviour and maintain systems that support the necessary changes.

However, these strategies are critical to ensuring that shared care services are better structured to achieve sustained improvements in mental health care.

• Kelly BJ, Perkins DA, Fuller JD, Parker SM (2011). Shared care in mental illness: a rapid review to inform implementation. International Journal of Mental Health Systems, 5:31

This article features in the 1 December 2011 edition of PHC RIS eBulletin. The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php

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Previous posts in this series

• Suggesting some long-term goals for mental health reform

• Important for mental health: a fair society and a good start to life

• Don’t rush the roadmap for national mental health reform: Alan Rosen

• What matters for people living with psychotic illness

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