Are collaborative care approaches effective for people with SMI who are living in the community?

Problem

Many individuals with psychosis have suboptimal physical care and poor mental and physical health outcomes. Collaborative care for severe mental illness (SMI) is a community-based intervention, which typically consists of a number of components. The intervention aims to improve the physical and/or mental health care of individuals with SMI. There is no universally agreed definition of collaborative care; it is operationalised with a great degree of variation. Community mental health teams (CMHTs) have become the backbone of mental health services. There are however, problems with CMHT staff frequently having caseloads that are too high to allow sufficient contact time to work effectively with people with SMI and problems with continuity of care across the primary, secondary and the social care interface. NICE guidance for both schizophrenia and bipolar suggests there is surprisingly little evidence to show that they are an effective way of organising services. We are conducting a Cochrane review as there have been no syntheses of the evidence to support this model of care.

Approach

Our primary outcome of interest is quality of life. In this review we have included randomised controlled trials (RCTs) where interventions are described as collaborative care by the trialists AND are comprised of the four ‘core’ components: a) A multi-professional approach to patient care; b) A structured management plan in the form of evidence based protocols or guidelines; c) Scheduled patient follow-ups; d) Enhanced inter-professional communication. We will also include trials where the interventions are described as collaborative care by the trialists but are not comprised of the four core ‘core’ components. These will be compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI, defined as schizophrenia or other types of schizophrenia-like psychosis (e.g. schizophreniform and schizoaffective disorders), bipolar affective disorder or other types of psychosis.Electronic searches were performed on the Cochrane Schizophrenia Group Register of Trials and the Specialised Register of the Cochrane Common Mental Disorders Group and we contacted over 50 international experts in the field of collaborative care.

Findings

We have screened studies and have identified six potential trials. We are extracting the data from these and entering this on to RevMan software to enable the synthesis according to our pre specified protocol. We are also currently screening studies an additional update search.

Consequences

Mental health and primary care policy is weakly endorsing integrated primary care mental health. The review will help to provide some evidence about whether this is the right direction. The review may help to identify scope for the promotion of collaborative care in primary care and provide insight into potential opportunities for the implementation of NHS England’s Five Year Forward View strategy for people with severe mental illness.