Mental Health Collaborative Care and its Role in Primary Care Settings

Abstract

Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims under healthcare reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.

Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

“…Collaborative care models in primary care are a pragmatic and cost-efficient strategy for incorporating mental health into general medical care in primary care settings, 85 and can be used as a model for integrating treatment for depression into TB control programs. Such models have enhanced the control of medical diseases such as diabetes mellitus and coronary heart disease while improving depression symptoms, treatment adherence, satisfaction with care, functional status and overall quality of life.…”

“…Such models have enhanced the control of medical diseases such as diabetes mellitus and coronary heart disease while improving depression symptoms, treatment adherence, satisfaction with care, functional status and overall quality of life. 85–87 Treating depression has also been associated with greater suppression of viruses, reduction in cortisol levels and better treatment adherence, leading to higher overall survival rates. 86 Collaborative care involves more than simply co-locating a mental health professional within a primary care setting; it is defined as ‘a team-based, multicomponent intervention to enact care delivery redesign by systematically improving coordination of patient care through organizational leadership support, evidence-based provider decision-making, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources’.…”

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

“…Existing models for collaborative care include colocated pediatricians and child psychiatrists or psychologists; telephone mental health consultation services, including telepsychiatry (staffed by child psychiatrists, psychologists, social workers, or mental health coordinators); formal crosseducational sessions between mental health clinicians and pediatricians; and implementation of care managers on site. [64][65][66][67][68][69][70][71] Pediatricians who do not have colocated mental health services can support teen mothers with mental health needs by facilitating referrals to gateway organizations, such as the department of health, outpatient mental health programs, and communitybased organizations with wraparound services that include mental health care.…”

Depression in primary care: part 2—management

“…135 The CCM can improve physical and mental health outcomes in primary care with little to no net health costs 168. However, it has not been adopted widely outside well resourced or academic centers, as successful implementation requires alignment of financial incentives to support system redesign, adequate funding to sustain change, and adaptation to local contexts and practices 169170. New evidence from qualitative systems-wide analysis has shown that a multitude of structural factors (for example, co-location of care, electronic infrastructure), processes (team working, care coordination, quality outcome measurement), external contexts (reimbursement, licensing arrangements), and internal factors (organizational culture) interact with each other to either facilitate or hinder effective delivery of mental healthcare in primary care 171.…”