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

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

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).

1^st 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)

3 years

2 years

2 and 5 years

1 year

1 year

2 years

yes

yes

yes

yes

no

unclear

yes

yes

yes - staffed trained to deliver early intervention program

yes - training of research facilitators

no

no

yes - used to promote identification and treatment by outlining medications to use without sequencing individual agents

yes

no

no

no

unclear

no

yes

no - team assessed as to when patients were ready for a specific treatment modality

no

no

unclear

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

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

yes

yes

yes - focus on problem solving and development of skills to cope with illness

no

yes

no

yes

yes

yes- team based

yes

yes

yes

yes

yes - weekly

yes

yes

yes

yes

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

yes

yes

yes

yes

yes

yes

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

yes

yes

yes

yes

yes

yes