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Collaborative Mental Health Care Versus Care as Usual in a Primary Care Setting: A Randomized Controlled Trial

Ms. van Orden, Mr. Hoffman, Dr. Haffmans, and Dr. Hoencamp are affiliated with the Research Department, Parnassia Bavo Group, Monsterseweg 83, the Hague, 2553 RJ, Netherlands (e-mail: m.vanorden{at}parnassiabavogroep.nl). Dr. Haffmans and Dr. Hoencamp are also with the Department of Psychology, Leiden University, Leiden, Netherlands, with which Dr. Spinhoven is affiliated.

OBJECTIVE: This study compared the effectiveness of treating common mental disorders in a collaborative care program in a primary care setting and the effectiveness of treating such disorders through traditional referral of patients to mental health services. METHODS: In a cluster randomized controlled trial, 27 general practitioner practices in the Netherlands were designated to provide either collaborative care or usual care. In the collaborative care condition, a mental health care professional worked on site at the primary care practice and was available to provide patients a maximum of five appointments if they were referred by the general practitioner. If indicated, referral to specialized mental health services followed. In the usual care condition, if indicated, general practitioners would refer patients to off-site specialized mental health services. The study included 165 patients. At baseline and at three, six, and 12 months, the study assessed patients' psychopathology, patients' quality of life, and patients' and general practitioners' satisfaction with the treatment provided. Delay in seeing a mental health provider, duration of treatment, number of appointments, and related treatment costs were assessed at 12 months. The data were analyzed with hierarchical linear models. RESULTS: Level of patients' psychopathology and quality of life significantly improved over time, and there were no significant differences between models of care. There was no significant difference in patients' satisfaction with care in either condition. The collaborative care condition resulted in significantly higher satisfaction with services among general practitioners, shorter referral delay, reduced time in treatment, fewer appointments, and consequently lower treatment costs. CONCLUSIONS: Collaborative care for a heterogeneous group of persons with common mental disorders seems to be as effective as the usual practice of referral to mental health services for reducing psychopathology, but it is significantly more efficient regarding referral delay, duration of treatment, number of appointments, and related treatment costs.

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