The development of a patient-reported experiential model of care navigation for complex mental health needs in primary care: Process evaluation findings from Link-me

Problem

Care navigation has been identified as effective to support patients to navigate complex health systems, treatment pathways, reduce barriers to accessing services and, to attend to social and health needs. Literature indicates however that diversity in care navigation models does exist and there is no consensus on the ingredients of such models for primary care. There is some literature on positive experiences for patients and for supporting coordination of care across sectors (e.g. from hospital to primary care). However, the evidence for whether care navigation results in improved mental health outcomes is limited; particularly for complex mental health needs in the primary care setting. In the Link-me randomised controlled trial we tested whether care navigation would improve mental health outcomes for people with severe mental health symptoms.

Approach

Link-me was a multifaceted, digitally supported, and systematic approach to stepped care for mental health. A patient completed Decision Support Tool (DST) allocated people to minimal/mild, moderate or severe groups based on predicted depressive and anxiety symptom severity in three months’ time. Treatment pathways were matched to group allocation. Those with severe symptoms were randomized to receive usual care or care navigation. Care navigation comprised a non-mental health professional delivering care planning, coordination, and funding to support individuals to find and access services to improve mental health for up to eight structured contacts. The care navigation model delivered in Link-me was informed by collaborative care and motivational interviewing. As part of the process evaluation for the trial 32 semi-structured interviews were conducted with eligible participants who took part in care navigation. Thematic analysis was conducted to identify critical elements of patient experiences shared across all 32 interviews and a patient reported experiential model of care navigation was developed.

Findings

There were 420 patients randomized to care navigation and 216 engaged in the intervention across the 23 participating general practices. Interview analysis identified shared positive experiences across the group in terms of setting priorities, developing plans for actions, and receiving support and linkages to services. For some patients this led to greater self-confidence and the ability to take ownership of their own health beyond care navigation. Based on these shared experiences we developed a patient-reported experiential model of care navigation for mental health in primary care. Six interrelated mechanisms of action were also identified: dialogue and affirmation, insight and self-reflection, self-responsibility and self-confidence.

Consequences

Care navigation can improve care experiences and mental health outcomes amongst those with more severe symptoms. Identification of the mechanisms of action for care navigation is essential for future implementation in primary care.