Collaborative care for treating common mental disorders in the community. Developing a clinical pathway for early intervention in Southeast Tuscany

Abstract

IntroductionCommon mental disorders (CMD) have a 12-month prevalence over 7% in the Italian population. Only 16,9% of people are treated by the health services, despite the high cost in disability and loss of productivity.ObjectivesTo improve access to low-intensity CBT (LI-CBT) treatments in primary care.AimsTo organize a clinical pathway in which general practitioners (GPs) identify the early signs of CMD and promote a collaborative care with a team of mental health practitioners (MHPs).MethodsA small team of MHPs outlined and implemented, in collaboration with a group of 9 GPs, a clinical pathway to treat CMD in stepped care. Guided self-help was the first and main intervention. Group and individual CBT were offered–when needed–as a second and third step. If the user opted for drug treatment, a psychiatrist conducted one or two sections of consultation to the GP. The MHP team was fully integrated within the community mental health center (CMHC). PHQ-9 and GAD-7 were rated at each appointment.ResultsWith a mean of 5,3 appointments, 90 persons were treated in 1 year. 68% reached recovery (both PHQ-9 and GAD-7 < 10), a result in line with the best performing English Clinical commissioning groups in the IAPT project.ConclusionsA small multi-professional team of MHP can build with GPs a simple clinical pathway able to reach high standards of care with relatively small resources offering LI-CBT integrated with drug treatment and high intensity care.Disclosure of interestThe authors have not supplied their declaration of competing interest.