Mental Health Linkage Agreement

A primary link in mental health care was defined as follows: 1. Linkage is the process used to link two or more services in the delivery of primary clinical mental health care. Meta-analysis of 42 studies by Harkness and Bower [61] found that a positive service delivery outcome occurred when on-site psychiatrists performed psychological and psychosocial interventions in GP offices. Local psychiatrists have been associated with a significant reduction in GP visits, psychotropic prescription, prescription costs and mental health referral rates. Bower and Rowland [62] conducted a meta-analysis of six studies comparing the clinical effectiveness of accredited primary care consultants with regular care. They found greater clinical efficacy in the short-term counselling group (one to six months), based on psychological symptom scores; However, there was no difference after 12 months. There was also no difference between patients who received counselling and those who received usual care at any given time, in terms of overall social function. Our analysis used a narrative and thematic synthesis approach due to the variability of the links used and the measures reported. For the quantitative analysis of efficacy reported in this article, we focused on the results of the 42 randomised controlled trials (RCTs) of collaboration in primary mental health care. These studies provided the strongest evidence of efficacy.

Our synthesis of data from these RCTs included tabular presentation of the proportions of studies in which a significant outcome was reported. Studies on depression provided the most important evidence of clinical effectiveness (12 studies on depression and/or dysthymia and 2 studies on depression with an associated risk of alcohol consumption) [12-25]. Of these, nine studies involved a general adult population and four involved a population aged 60 years or older. The remaining 9 RCTs investigated bipolar disorder [26], panic disorder [27,28], unspecified `severe or long-term mental illness` [29-31], and mixed disorders [32,33]. A descriptive account of correlations and results can be obtained from a closer look at the two largest studies in the review, IMPACT and PRISM-E, as both are well described in a number of published articles. Both were conducted in the United States and used links from the series of “direct collaborative activities” plus “agreed policies” and “communication system.” IMPACT employed depression care specialists (DCS), nurses or psychologists with special education training who were expertly supervised by a psychiatrist and a family physician [44-52]. DCS`s role included working with patients and the primary care physician to conduct an assessment, patient education, care management, primary care problem-solving treatment, and a relapse prevention plan. Treatment followed a gradual nursing process that was discussed at team meetings. PRISM-E included two forms of collaboration: integrated care clinics and enhanced off-site specialized referral services [53-59]. Integrated clinics brought together mental health and addictions specialists in primary care, while expanded referral services to mental health and addictions specialists located separately within two to four weeks. Number of randomised post-linkage trials based on significant results reported A narrative and thematic review of English-language articles published between 1998 and 2009. Studies on analytical, descriptive and qualitative designs were included in Australia, New Zealand, the United Kingdom, Europe, the United States and Canada.

Data were extracted to determine which service linkages were used in collaborative studies in primary mental health care. Results from randomised trials were compiled to show the proportion of clinical, service delivery and economic benefits. 2. HMP includes early intervention, treatment, education and health promotion for individuals, as well as pathways to specialized care. With the transition to community care and the increased involvement of general mental health care providers, the need for health care partnerships in mental health policies was highlighted. In existing health system structures, active strategies that enable effective partnership are unclear. The objective of this study was to review evidence from the peer-reviewed literature on the effectiveness of service linkages in primary mental health care. Hypothesis B: Patients who are randomly assigned to the liaison system have fewer arrests than witnesses during this 24-month period. Hypothesis A: Patients randomized to the linking system are more likely to be discontinued during the 24-month study period than patients who are not in the system, based on administrative data (RAP) provided by GBI. Most of the evidence supporting links in primary mental health care was generated from studies of adults with high-prevalence disorders (usually depression).

These studies have reported clinical benefits such as reduced symptoms, reduced severity, better response to treatment, and improvements in physical and social functions. Improvements in service delivery, such as targeted referrals, reduced hospitalization rates, and patient-centered engagement in treatment, such as. B increased use and self-efficacy with appropriate medications and adherence to other treatments. There was less evidence on service linkages for the low prevalence of severe mental disorders (p.B schizophrenia). We found very little evidence in the peer review literature on the key links between mental health services outside the health sector (housing, employment and well-being) that would be most important for the implementation of a recovery model. The recovery model is a treatment concept in which a service environment is designed so that patients have primary control over decisions about their own care [69]. Although there are evaluations of these links in program reports, they have not yet been published in the peer-reviewed literature. Australia`s first national mental health policy [1] in 1992 aimed to shift care from institutions to general health and welfare services.

Since then, the importance of partnerships between the different health and human services sectors has been emphasized. The Second National Mental Health Plan of 1998 [2] and the Australian National Mental Health Strategy of 2004 [3] called for joint planning, coordination of services and the development of links between different providers. This has been spelled out in the Council of Australian Governments` (COAG) National Mental Health Action Plan [4] and, more recently, in the Fourth National Mental Health Plan[5]. In 2009, Australia`s National Health and Hospital Reform Commission reported that access to and collaboration between support services is essential to the recovery and self-determination of people with mental illness [6]. Australian programmes to promote greater involvement of primary mental health care in the training of general practitioners and access to related mental health professionals have been implemented over the past decade [7]. The strongest evidence emerged for interventions that used a combination of broad categories of linkages comprising at least one component of each of the “direct collaborative activities”, “agreed guidelines” and “communication systems”. These were associated with statistically significant positive clinical, service delivery and economic outcomes. There was no evidence to support service agreements, either as a single strategy or in combination with other strategies. These findings suggest that successful collaborative clinical programs in primary mental health care use multiple connections that affect the direct work of clinicians, more than the management level agreement between services.

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