Collaborative Care: An Exploration into Core Tenets, Fidelity, and Policy
Nearly half of all people with a diagnosable mental health problem also have a long-term physical condition such as diabetes, asthma or coronary heart disease. Such co-existence of mental and physical health problems has a number of serious adverse consequences, both for patients and for the health system. These include poorer clinical outcomes, lower quality of life, reduced ability to manage physical symptoms effectively and significantly increased costs of care.
The co-existence of health problems calls for a whole-person approach to intervention which seeks to integrate treatment for mental and physical health needs in a seamless way. The strongest evidence for such integration relates to the collaborative care model, which has now been the subject of more than hundred trials, mostly in the US but with a small number in NHS settings.
Collaborative care is a form of systematic team-based care with a number of ingredients, including: a case manager responsible for the coordination of different components of care; a structured care management plan, shared with the patient; systematic patient management based on protocols and the tracking of outcomes; delivery of care by a multidisciplinary team which includes a psychiatrist; and collaboration between primary and secondary care.