Across Europe, national and local health authorities are engaging in costly re-organisations of mental health care systems, which often focus on one core question, namely, whether mental health systems should be functional or integrated. In an integrated system, in- and out-patient mental health care is coordinated by the same main clinician and team, with individuals seeing the same clinician both within the hospital and community. In contrast, within functional systems, in- and out-patient care is coordinated by different teams working in different services.
At present, these costly service re-organisations are occurring in the absence of an empirical evidence base regarding both effectiveness and cost-effectiveness of integrated and functional systems. The COFI project, led by the Unit for Social and Community Psychiatry, is currently conducting a large-scale non-randomised controlled trial comparing integrated and functional systems in 5 countries (Belgium, Germany, Italy, Poland, United Kingdom) where both systems coexist.
The COFI project will recruit and prospectively assess more than 5000 patients with major mental disorders over a 12 month period. Individuals admitted to adult acute psychiatric wards will be assessed within 48 hours of admission and asked to complete a range of measures, including their initial satisfaction with care. The effectiveness and cost-effectiveness of the two systems will be then compared over a 12-month follow up period. We will assess clinical and social outcomes (including quality of life), patients' health and social needs, safety and quality of care of patients. We will also investigate patients' and clinicians' experiences in the two systems and identify the policies and legislative frameworks determining practice.
The impact on mental health policies at a European level and at national levels will be maximized by the development of guidelines for policy decision-making based on study findings. Other dissemination methods will include: production of scientific papers, use of popular media and new technologies, contacts with relevant agencies in all European countries and workshops for policymakers, user/carer organisations and mental health professionals.
- Which system of mental health care e.g. integrated or functional is more effective in terms of:
- Clinical outcomes such as hospital admission, number of inpatient days
- Social outcomes including friendship
- Quality of life for people using mental health services
- Safety and quality of care received
- Which service is the most effective for certain patient groups (e.g. first episode, individuals with co-morbid physical health problems)?
- What is the experience of integrated and functional systems for both patients and the clinicians working within each system.
- A non-randomised controlled trial of over 5000 patients recruited from five different European counties will provide prospective data on clinical and social outcomes. Individuals will be recruited within two days of admission to a psychiatric ward and followed up one-year later. Within England, 11 NHS mental health trusts are currently participating in the research, with recruitment occurring in 25 different hospitals.
- We will assess outcomes for different groups of patients defined by characteristics such as number of previous admissions, existing co-morbidities to provide information about which system works best for different people.
- We will be conducted in-depth interviews with individuals who have been admitted to either integrated or functional hospitals during the study period. The qualitative interviews will focus on the person's experience of being in hospital and their transition back into the community. We will also be interviewing different staff members who work in the hospitals and community to understand their experience of providing services.
COFI represents a new approach to high quality research on mental health care systems. The study will produce clear indications for policy decision-making on mental health care and guide the re-organisation of services on the basis of empirical evidence. The findings will also generate evidence on how to tailor services to the needs of specific populations (e.g. first-episode patients, patients with different diagnoses) and how to maximize patient satisfaction with care.
- Prof. Stefan Priebe
- Dr Domenico Giacco
- Dr Victoria Bird
- Aleksandra Matanov
- Agnes Chevalier
- Eleni Ntala
- Kimberley Anderson
- Neelam Laxhman
Omer S, Priebe S, Giacco D. (2015) Continuity across inpatient and outpatient mental health care or specialisation of teams? A systematic review. European Psychiatry 30(2):258-70
European Commission, Directorate General for Research and Innovation