Literature Collection

OBJECTIVES: Community mental healthcare requires the collaboration of multiple services to meet the needs of local populations. Accessing mental health care in England often involves the collaboration of primary and secondary healthcare services. This paper presents the findings from an evaluation of 'boundary spanning' processes and practitioner roles aiming to reduce service fragmentation and improve access to mental healthcare. METHODS: Forty-one qualitative interviews with professionals across local healthcare providers were conducted in Peterborough (East England) to assess the impact of boundary spanning processes and practitioner roles and were analysed thematically. RESULTS: Structured boundary spanning processes and professional roles were found to facilitate communication and knowledge exchange between primary and secondary mental healthcare services, leading to optimisation of GPs' decisions about individuals' treatment pathways, and to improvements in service accessibility. Yet, effectiveness was reported as conditional on GPs' engagement, as well as the decentralised structure of primary care settings. CONCLUSION: Community mental healthcare organisations could utilise boundary spanning interventions to flex organisational barriers between primary and mental healthcare and optimise accessibility of service users to mental health services. Boundary spanning processes and professional roles can be used to inform national and local care integration strategies.

Objective: Previous guidelines and planning documents have identified the key role primary care providers play in delivering mental health care, including the recommendation from the WHO that meeting the mental health needs of the population in many low and middle income countries will only be achieved through greater integration of mental health services within general medical settings. This position paper aims to build upon this work and present a global framework for enhancing mental health care delivered within primary care.Methods: This paper synthesizes previous guidelines, empirical data from the literature and experiences of the authors in varied clinical settings to identify core principles and the key elements of successful collaboration, and organizes these into practical guidelines that can be adapted to any setting.Results: The paper proposes a three-step approach. The first is mental health services that any primary care provider can deliver with or without the presence of a mental health professional. Second is practical ways that effective collaboration can enhance this care. The third looks at wider system changes required to support these new roles and how better collaboration can lead to new responses to respond to challenges facing all mental health systems.Conclusions: This simple framework can be applied in any jurisdiction or country to enhance the detection, treatment, and prevention of mental health problems, reinforcing the role of the primary care provider in delivering care and showing how collaborative care can lead to better outcomes for people with mental health and addiction problems.

Depression is a common mental illness. Primary care providers are uniquely positioned to screen and manage patients with depression. A clinical pathway protocol may ensure timely screening, diagnosis, and treatment of depression. This evidence-based quality improvement project used an integrated team approach to implement a depression clinical pathway protocol (DCPP) at a multisite faith-based federally qualified health center. Results showed an improvement in one clinical quality measure, screening, and follow-up for depression, whereas center providers reported the protocol saved time and was easy to use. Using a DCPP may bridge the gap in depression screening and follow-up care.