Does one size really fit all? The effectiveness of a non-diagnosis-specific integrated mental health care program in Germany in a prospective, parallel-group controlled multi-centre trial

Annabel Sandra Mueller-Stierlin,Thomas Becker,Katrin Herder,Julia Walendzik,Uemmueguelsuem Dinc,Marco Holzmann,Reinhold Kilian,Stefanie Prinz,Matthias Schützwohl,Marina Julia Helmbrecht,Nadine Rosenfeld

doi:10.1186/s12888-017-1441-9

Abstract

BackgroundThe Network for Mental Health (NWpG-IC) is an integrated mental health care program implemented in 2009 by cooperation between health insurance companies and community mental health providers in Germany. Meanwhile about 10,000 patients have been enrolled. This is the first study evaluating the effectiveness of the program in comparison to standard mental health care in Germany.MethodsIn a parallel-group controlled trial over 18 months conducted in five regions across Germany, a total of 260 patients enrolled in NWpG-IC and 251 patients in standard mental health care (TAU) were recruited between August 2013 and November 2014. The NWpG-IC patients had access to special services such as community-based multi-professional teams, case management, crisis intervention and family-oriented psychoeducation in addition to standard mental health care. The primary outcome empowerment (EPAS) and the secondary outcomes quality of life (WHO-QoL-BREF), satisfaction with psychiatric treatment (CSQ-8), psychosocial and clinical impairment (HoNOS) and information about mental health service needs (CAN) were measured four times at 6-month intervals. Linear mixed-effect regression models were used to estimate the main effects and interaction effects of treatment, time and primary diagnosis. Due to the non-randomised group assignment, propensity score adjustment was used to control the selection bias.ResultsNWpG-IC and TAU groups did not differ with respect to most primary and secondary outcomes in our participating patients who showed a broad spectrum of psychiatric diagnoses and illness severities. However, a significant improvement in terms of patients’ satisfaction with psychiatric care and their perception of treatment participation in favour of the NWpG-IC group was found.ConclusionsProviding integrated mental health care for unspecific mentally ill target groups increases treatment participation and service satisfaction but seems not suitable to enhance the overall outcomes of mental health care in Germany. The implementation of strategies for ameliorating the needs orientation of the NWpG-IC should be considered.Trial registrationGerman Clinical Trial Register DRKS00005111, registered 26 July 2013.

Highlights

The Network for Mental Health (NWpG-Integrated care (IC)) is an integrated mental health care program implemented in 2009 by cooperation between health insurance companies and community mental health providers in Germany
Providing integrated mental health care for unspecific mentally ill target groups increases treatment participation and service satisfaction but seems not suitable to enhance the overall outcomes of mental health care in Germany
Beyond generic community mental health teams, more intensive community-based mental health care approaches such as Home Treatment (HT) and Crisis Resolution Teams (CRT) for short-term outpatient treatment of acute psychiatric crises or Assertive Community Treatment [5] and Intensive Case Management (ICM) [6] for the longterm care of patients have been established in many countries [6,7,8,9,10,11,12,13]

Summary

Introduction

The Network for Mental Health (NWpG-IC) is an integrated mental health care program implemented in 2009 by cooperation between health insurance companies and community mental health providers in Germany. This is the first study evaluating the effectiveness of the program in comparison to standard mental health care in Germany. Comprehensive, integrated and responsive mental health and social care services provided by multi-professional teams in community-based settings are regarded by most experts as a fundamental basis of adequate contemporary mental health care [1,2,3,4]. In spite of the international evidence in favour of integrated care [6], in Germany ACT, ICM, HT, CRT or other intensive outreach community mental health care programmes have been rarely implemented in routine psychiatric care so far [14]. It is expected that effectiveness and efficiency of the German mental health care system can be significantly improved by a shift of resources from inpatient to outpatient care [14, 22]

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