Collaborative care approaches for people with severe mental illness

Area of Science:

• Psychiatry
• Public Health
• Health Services Research

Background:

• Severe mental illness (SMI) impacts individuals in the community, necessitating effective care models.
• Collaborative care aims to enhance physical and mental health services through interdisciplinary collaboration.
• This review updates previous findings on collaborative care for SMI.

Purpose of the Study:

• To evaluate the effectiveness of collaborative care versus standard care for community-dwelling individuals with SMI.
• To assess impacts on quality of life, mental state, and psychiatric admissions.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing collaborative care with standard care for SMI.
• Searches conducted across multiple databases including Cochrane registers, MEDLINE, Embase, and PsycINFO.
• Data extracted and analyzed using risk ratios and standardized mean differences, with GRADE assessment for evidence certainty.

Main Results:

• Eight RCTs involving 1165 participants were included.
• Low to very low-certainty evidence indicated no significant difference in quality of life, mental state, or psychiatric admissions at 12 months.
• One study suggested improved disability with collaborative care, but evidence was low-certainty. Collaborative care showed mixed cost-effectiveness.

Conclusions:

• Current evidence does not support collaborative care as more effective than standard care for primary outcomes in SMI at 12 months.
• Improved reporting, higher-quality RCTs, and investigation of underlying mechanisms are recommended.
• Caution is advised when interpreting the effectiveness of collaborative care based on existing evidence.