Abstract
BackgroundWith the move to community care and increased involvement of generalist health care providers in mental health, the need for health service partnerships has been emphasised in mental health policy. Within existing health system structures the active strategies that facilitate effective partnership linkages are not clear. The objective of this study was to examine the evidence from peer reviewed literature regarding the effectiveness of service linkages in primary mental health care.MethodsA narrative and thematic review of English language papers published between 1998 and 2009. Studies of analytic, descriptive and qualitative designs from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted to examine what service linkages have been used in studies of collaboration in primary mental health care. Findings from the randomised trials were tabulated to show the proportion that demonstrated clinical, service delivery and economic benefits.ResultsA review of 119 studies found ten linkage types. Most studies used a combination of linkage types and so the 42 RCTs were grouped into four broad linkage categories for meaningful descriptive analysis of outcomes. Studies that used multiple linkage strategies from the suite of "direct collaborative activities" plus "agreed guidelines" plus "communication systems" showed positive clinical (81%), service (78%) and economic (75%) outcomes. Most evidence of effectiveness came from studies of depression. Long term benefits were attributed to medication concordance and the use of case managers with a professional background who received expert supervision. There were fewer randomised trials related to collaborative care of people with psychosis and there were almost none related to collaboration with the wider human service sectors. Because of the variability of study types we did not exclude on quality or attempt to weight findings according to power or effect size.ConclusionThere is strong evidence to support collaborative primary mental health care for people with depression when linkages involve "direct collaborative activity", plus "agreed guidelines" and "communication systems".
Highlights
With the move to community care and increased involvement of generalist health care providers in mental health, the need for health service partnerships has been emphasised in mental health policy
Australian programs to promote greater primary mental health care involvement in General Practitioner (GP) training and access to allied mental health professionals have been implemented in the past decade [7]
Even though policies continue to emphasise the importance of effective mental health linkages between primary care (PC), specialist and community health services, the form these linkages should take remains unclear
Summary
With the move to community care and increased involvement of generalist health care providers in mental health, the need for health service partnerships has been emphasised in mental health policy. The objective of this study was to examine the evidence from peer reviewed literature regarding the effectiveness of service linkages in primary mental health care. Even though policies continue to emphasise the importance of effective mental health linkages between primary care (PC), specialist and community health services, the form these linkages should take remains unclear. This narrative review was conducted in response to key national government policy priorities relating to the need for improved service linkages in the Australian health care system. The first objective was to examine evidence from the international literature about the effectiveness of linkages and combinations of linkages in primary mental health care. The second objective was to describe the factors that enable the development of these linkages, which is reported in a companion paper
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