[Improving population mental health by integrating mental health care into primary care].
Bibliographic record
Abstract
Objective The objectives of this review were to identify and compare major international initiatives aiming to integrate mental health services in primary care and to summarize the lessons learned for similar integration efforts in the province of Quebec, Canada.Methods We conducted a narrative review of the literature guided by a conceptual framework drawn from the literature on integrated care. We identified relevant initiatives to support primary mental health care integration through Pubmed searches and through previous systematic reviews on this topic. We then selected those initiatives that provided sufficient details on their key characteristics, outcomes, and implementation issues (e.g. barriers, facilitators). We focused our analysis on large-scale initiatives as these offered the most potential for impacts on population mental health. This process resulted in the selection of 20 initiatives that were described in 153 articles and reports. Our synthesis was guided by our conceptual framework, which distinguishes between five types of integration, namely clinical, professional, organizational, systemic and functional integration.Results Of the 20 primary mental health care integration initiatives, 3 targeted youth, 14 targeted adults or multiple age groups, and 3 were targeted towards seniors. Most initiatives aimed to implement collaborative care models for common mental disorders in primary care. Other initiatives focused on co-locating mental health professionals in primary care, supporting the emergence of a diversity of integration projects led by community-based primary care practices, or the merger of primary care and mental health organizations. Most initiatives were based on clinical, professional and functional integration strategies. Across initiatives, a range of positive outcomes were reported, notably to the accessibility and quality of services, the satisfaction of patients and providers, the costs of services, and impacts on patients' health and quality of life. Integration initiatives encountered many common barriers to implementation. However, steps taken to properly prepare and execute the implementation process, as well as ensure the sustainability of initiatives, helped initiative leaders to overcome certain barriers. The lessons for Quebec include the need to continue to reinforce evidence-based models of collaborative mental health care in primary care and promote a culture of continuous quality improvement and a more widespread use of information technologies that can support integrated care.Conclusion This review shows that integrating mental health services into primary care is a complex process that depends on a variety of strategies occurring at multiple levels of the healthcare system. However, it is also a unifying process that holds much potential to significantly impact the mental health and well-being of populations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".