Table 1 Evidence for the benefits of shared care

Access and Equity

• Improved access by reducing barriers to availability of integrated care with primary care or improved access to specialist care (Druss 2001, Harrison-Read 2002, PRISM-E, van Orden 2009).

• Improved access to outpatient services, rehab services, and an increase the number of people receiving follow-up, case management and review of their medication (Byng 2004, Gilmer 2010, Rosenheck 2003)

• Increased ability to target high priority groups through tailored programs linked with relevant services (e.g. cultural groups, age-based services, homelessness) (Asanow 2009, Gilmer 2010, Rosenheck 2003)

• Reduced impact of perceived stigma on help seeking for mental health problems (PRISM-E, Gavin 2008)

Acceptability and stigma

• Reduced unmet need for treatment (PRISM-E (73% of participants))

• Improved cultural appropriateness of service (IMPACT, PRISM-E)

Comprehensiveness

• Increased efficacy of pharmacological/psychological treatments in primary care. Treatment course is generally predictable and with good step up/step down algorithms (IMPACT, PROSPECT,CALM, Bower 2006, Gilbody 2006))

• Capacity to match intensity of intervention to patient need (stepped care) (IMPACT, PROSPECT, CALM)

• Improved capacity of generalist services to meet full range of patient needs (IMPACT, PRISM-E)

• Improved communication between levels of care (primary and specialist) (Craven 2006, PRISM-E)

• Improved capacity to address mental health aspects of physical illness and chronic disease (Byng 2004, Druss 2001, Gilmer 2010, Rosenheck 2003, PRISM-E, IMPACT)

• Improved skill of generalist health worker in mental health care (Fuller 2009)

• Considers client preference in the choice of care delivered (IMPACT, CALM)

• Promotes engagement in care (e.g. via link worker) (Byng 2004, Oxman 2003)

Continuity

• Single point of contact to review care progress and needs (e.g. through primary care) (Druss 2001, PRISM-E)

Outcomes: clinical, functional. social

• Evidence of improved clinical outcomes (psychiatric) (Bauer 2006, Bertelsen 2008, Bower 2006, Fuller 2009, Gilbody 2006, Simon 2006, PRISM-E (6 mths only), IMPACT, PROSPECT, RESPECT-D, CALM)

• Evidence of improved clinical outcomes (physical and medical) (Druss 2001, IMPACT)

• Evidence of reduced hospitalisation for mental health problem (Bauer 2009)

• Evidence of improved social functioning and/or quality of life (Bauer 2009, Gilmer 2010, Rosenheck 2003, IMPACT)

• Greater satisfaction with care (Asarnow 2009 (6 months), Bauer 2009, Gilmer 2010, Rosenheck 2003, PRISM-E, IMPACT, RESPECT-D)

• Increased ability of consumers to manage their own care (IMPACT)

• Reduced or equal client costs (Bauer 2006, Bower 2006, Druss 2001, Katon 2002, van Orden 2009)

Cost ¹

• Increased health care costs of initial set-up (first 12 months) balanced against cost savings in following year (Katon 2002, Katon 2006, Simon 2007)

• Reduced in-patient costs (Bauer 2009, Byng 2004, Druss 2001)

• Cost-offset effects on non-mental health-related ambulatory care services (IMPACT)

• Reduction in costs to other systems (e.g. justice) (Gilmer 2010, Rosenheck 2003)