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Table 3 The core components of shared care models for severe and persistent mental disorders

From: Shared care in mental illness: A rapid review to inform implementation

  COPERATIVE STUDIES PROGRAM 430 Bauer 2009 Simon 2006 OPUS Bertelson 2008 MENTAL HEALTH LINK Byng 2004 Druss 2001 Gilmer 2010
Process of care Specialty mental health team (.5 fulltime-equivalent (FTE) nurse and a .25 FTE psychiatrist) Nurse care managers with at least 5 years of clinical psychiatric experience Assertive Community Treatment, family treatment and social skills training Facilitation based QI programme designed to improve communication between general practice and community mental health and improve systems of care within general practice (including roles of link worker and psychiatrist) Integrated primary care and mental health clinic Full service partnerships and subsidised housing and full fidelity Assertive Community Treatment by team- based services with a focus on rehabilitation and recovery
Condition Bipolar disorder and associated co-morbidities including: substance use disorders, anxiety disorders, any current psychiatric co-morbidity and active medical co-morbidity requiring treatment Bipolar spectrum disorder diagnosed during previous 12 months (bipolar disorder type I or type II, schizoaffective disorder, or cyclothymia). 1st episode psychosis Long term mental illness - chronic psychosis, and disabling neuroses SMI & homeless; co-morbid drug and alcohol abuse. SMI (schizophrenia, bipolar disorder, or major depression)
Length of follow up 3 years 2 years 2 and 5 years 1 year 1 year 2 years
Screening yes yes yes yes no unclear
Additional training for staff yes yes yes - staffed trained to deliver early intervention program yes - training of research facilitators no no
Treatment algorithm yes - used to promote identification and treatment by outlining medications to use without sequencing individual agents yes no no no unclear
Formal stepped care no yes no - team assessed as to when patients were ready for a specific treatment modality no no unclear
Enhanced communication between health providers no yes- contact tracking, structured assessment, and standardised feedback reports to providers unclear yes - formal communication guidelines around referral, discharge and professional roles and patient management yes - e-mail, telephone, and face-to-face discussion unclear
Care management location outpatient clinic behavioural health clinics primary care office or in patient's home or other places in the community general practice primary care clinic and mental health clinic adjoining community
Patient education/self management yes yes yes - focus on problem solving and development of skills to cope with illness no yes no
Case management yes yes yes- team based yes yes yes
Specialist supervision yes yes - weekly yes yes yes yes
Care coordination yes - scheduling appointments and follow-up for missed appointments, and with mental health and medical-surgical providers yes yes - across team and social services and other involved institutions yes yes - scheduling appointments and follow-up of missed appointments between the two clinics unclear
Follow up provided to patient yes yes yes yes yes yes
Crisis support yes yes yes - crisis plan developed with each patient. Patients given out of hours contact number for response the following day unclear unclear yes - 24/7
Standardised outcome measure yes yes yes yes yes yes