Literature Collection

Over the past two decades, the value and benefits of integrated mental health care services have been increasingly recognised. Despite the potential benefits, barriers exist at primary care level to receiving mental health care services, interfering with continuity of care. We conducted semi-structured interviews with mental healthcare users at a primary care clinic in South Africa, to explore their experiences of receiving mental health care services. A convenience sample of 15 participants identified challenges such as limited infrastructure, organisation, medication, services in local communities, allied mental health care services, communication and long waiting times. Mental health care users felt uncared for and disrespected, especially if they were treated by unskilled and overworked staff. Mental health care users described clinic visits as stressful and frustrating. Mental health care users described marked challenges in mental health care service provision in a South African primary health care setting.

With the increased concern regarding the negative impact that care in silos has on patients and the health care system, there is growing interest in integrated models of care especially for individuals with co-occurring physical and mental health conditions. Although generally applied in a community setting, we adapted and implemented an evidence-based integrated model of care, the collaborative care model (CCM) in an adult and a pediatric hospital-based outpatient clinic. Enrolment was criteria based and management was measurement driven. The model is team based and consists of new roles for its members including the patient, the care manager, the primary care clinician, and the psychiatric consultant. A key role was that of the care manager who worked with the patient and engaged primary care. The care manager also organized team-based treatment planning in systematic case reviews that contributed to the care plan. Support for training of the new and changes in roles is underscored. In this communication we comment on our initial experience of applying the CCM to the hospital outpatient setting.

This summary highlights the recommendations from the Promoting Integrated Care Sustainability project for moving integrated care to the mainstream of Colorado's health care system.Includes measurement tools.