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

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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1441-9) contains supplementary material, which is available to authorized users.

Effectiveness and cost-effectiveness of a community-based mental health care programme (GBV) for people with severe mental illness in Germany: study protocol for a randomised controlled trial

“…With regard to developments in other countries, over the last decade, various pilot projects have been conducted in Germany to implement and evaluate different approaches for integrating medical-and community-based mental health care. The results of these studies are inconclusive with regard to the assessed effectiveness and efficiency of integrated mental health care approaches but also with regard to the generalisability of their outcomes [6][7][8][9][10][11]. This is mainly because, with one exception [8], none of these projects implemented evidence-based approaches to integrated mental health care, such as assertive community treatment or intensive case management.…”

“…In a recent study, we revealed that the additional provision of integrated mental health care components based on case management to people with mental illness, on the whole, was not more effective than CAU with regard to the primary outcome (empowerment) and most of the secondary outcomes (psychosocial impairment, met needs, and satisfaction). We suspected that this result was mainly because the services provided were insufficiently tailored to the individual needs of the service users [10].…”

“…The cut-off values for the three scales were derived from data from a previous study on integrated mental health care in Germany [10]. These cut-offs are ≤ 3.3 for mean EPAS total score, ≥ 4 for CAN unmet needs (sum score), and ≥ 12 for HoNOS total sum score.…”

“…The calculation of the expected effect size is based on the results of a previous study (IVPOWER) [10]. Since the total score of the scale for measuring empowerment in patients with affective and schizophrenic disorders (EPAS) as the primary outcome proved to be rather difficult and slow to change, a low effect size of 0.20 and a high power of 0.90 were chosen for the sample size calculation of the present study.…”

Implementation of the patient version of the evidence-based (S3) guideline for psychosocial interventions for patients with severe mental illness (IMPPETUS): study protocol for a cluster randomised controlled trial

“…In the first step, the sample size for an individual randomized study is calculated. Based on studies using the 'empowerment in the process of psychiatric treatment of patients with affective and schizophrenia disorders (EPAS)' scale [26], a medium effect (0.4 SD units) of the implementation intervention on the primary endpoint is expected. This effect is detectable with an error probability of 5% (alpha) and a power of 80% by a ttest for independent samples with a sample size of 2 × 100 participants (200 in total).…”