Collaborative care approaches for people with severe mental illness

Area of Science:

• Psychiatry
• Health Services Research

Background:

• Severe mental illness (SMI) affects community-dwelling individuals, necessitating effective interventions.
• Collaborative care is a community-based approach designed to enhance physical and mental health services for individuals with SMI.

Purpose of the Study:

• To evaluate the effectiveness of collaborative care versus standard care for community-based individuals with SMI.
• The primary outcome assessed was the rate of psychiatric admissions.

Main Methods:

• A systematic search of the Cochrane Schizophrenia Group Specialised register was conducted in April 2011.
• Included randomized controlled trials (RCTs) comparing collaborative care with standard care for adults diagnosed with SMI.
• Data extraction and quality assessment were performed independently by two reviewers.

Main Results:

• One RCT involving US veterans with bipolar disorder was included; no trials for schizophrenia were found.
• Collaborative care reduced psychiatric admissions at two years (RR 0.75, 95% CI 0.57 to 0.99) and three years (RR 0.72, 95% CI 0.53 to 0.99).
• Quality of life, specifically the Mental Health Component, improved with collaborative care (MD 3.50, 95% CI 1.80 to 5.20), but the Physical Health Component did not differ significantly.

Conclusions:

• No evidence exists to support the effectiveness of collaborative care for schizophrenia or related disorders.
• A single trial suggests potential benefits for bipolar disorder, but its high risk of bias limits recommendations.
• Further large, well-designed trials are required to establish the efficacy of collaborative care for SMI.