Abstract
ObjectiveStepped and collaborative care with outpatient psychotherapy as one treatment step is guideline-recommended for mental health care. To date, the experiences and evaluation of psychotherapists regarding collaboration and stepped care have been neglected. In order to improve collaborative mental health care, this qualitative study aimed at identifying psychotherapists’ perspectives and needs within collaboration and stepped care.MethodsSemi-structured qualitative interviews with 20 German outpatient psychotherapists were conducted and analyzed applying thematic analysis. The analysis was realized in a recursive process to first identify themes and then relate these themes back to the research questions with regard to collaboration and stepped care.ResultsCollaboration mainly took place in small networks, with general practitioners and psychiatrists as the most important partners and psychotherapists wishing to intensify collaboration. Main barriers for collaboration were seen in deficient resources and remuneration and in a perceived lack of esteem by other medical specialties. Stepped care was appreciated for intensified collaboration and low-threshold access to care. Doubts were cast on its implementation within current health care conditions, worries concerned a primacy of economic principles instead of patient-orientation. Among further needs, psychotherapists demanded increased knowledge about psychotherapy, especially among general practitioners.ConclusionPsychotherapists expressed ambivalent attitudes towards stepped and collaborative care, substantially influenced by health care conditions and the perceived own standing among care providers. Psychotherapists’ needs within stepped care comprise intensified collaboration, sufficient time, personal and financial resources for collaboration and opportunities for a constructive interprofessional dialogue.
Highlights
Despite an open access mental health care system in Germany, patients with mental disorders are often underdiagnosed and underserved [1]
Stigmatization and a lack of resources in specialized health care contribute to the problem and the fragmentation of health care in different settings further impedes diagnostics and treatment [2, 3]. This fragmentation includes the insufficient collaboration between primary care and specialized mental health care since most patients access health care via general practice [4, 5]
To improve health care for patients suffering from mental disorders, German and international guidelines recommend collaborative care as an evidence-based care model [6,7,8]
Summary
Despite an open access mental health care system in Germany, patients with mental disorders are often underdiagnosed and underserved [1]. Stigmatization and a lack of resources in specialized health care contribute to the problem and the fragmentation of health care in different settings further impedes diagnostics and treatment [2, 3]. This fragmentation includes the insufficient collaboration between primary care and specialized mental health care since most patients access health care via general practice [4, 5]. Further research is needed to clarify facilitators of a successful implementation in different health care settings and for a broader range of disorders and comorbidities [10,11,12,13,14,15]
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