Review of evidence-based practice in relation to adoption of consultation/liaison models in mental health service provision; implementation of a shared care approach between primary care and specialist mental health services.

This report outlines the findings and observations of shared care in mental health to support a series of recommendations, focused on improving integration across primary care and specialist mental health services, and to assist in implementing Sharing the Vision (StV) a mental health policy for everyone (Department of Health, 2020). The report includes a literature review, key stakeholder engagement sessions, and a series of case studies conducted by Xenon Health Solutions on behalf of National Mental Health Office, HSE Access and Integration. It involved a review of practice in relation to adoption of consultation/liaison models in mental health and implementation of shared care approaches between primary care and specialist mental health services.

This work examines the challenges and enablers of delivering shared care in primary care and specialist mental health services, as well as identifying what key actions can support the delivery of this approach. In essence, shared care covers the spectrum of models of care, service arrangements, types of treatment options and interventions delivered by a range of healthcare professionals. This is based on the individual’s needs at different time-points in their healthcare journey. The information from both the literature and stakeholder engagement sessions provides an evidence base for the development of key recommendations around the implementation of shared care approaches. By identifying best practice, enablers and barriers, research findings will help inform the most appropriate approach to implementation of shared care, in line with StV.

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P.37 3.3.1.2 Service Delivery Approach Consultation/Liaison - UK
In comparison to the CLIPP model, a different approach was tested in the UK (Copello et al., 2013). This was initially developed for Combined Psychosis and Substance Use Programme (COMPASS) for people with concurrent mental health and substance use issues with a focus on the people who use services (Copello et al., 2013). However, due to changes in demographics and demand to treat other mental health diagnoses, the programme expanded to include a range of mental health problems (depression, personality disorders and bipolar disorders). A total of 173 people using the services were included in the study with the majority referred from mental health services and a small number from addiction services. Outcomes measured included engagement in treatment, recognition of the importance and readiness and confidence to change, substance-related beliefs and severity of dependence, and changes in behaviour (Copello et al., 2013). The COMPASS consultation/liaison service was accessible to services based within a Mental Health National Health Service (NHS) foundation trust with the exception of outreach, early intervention, and homeless community mental health teams as they provide intensive programmes of care (Copello et al., 2013). The service was provided by a COMPASS practitioner as part of specialist mental health services.

Consultation/liaison service offered within COMPASS was time-limited starting with a structured specialist assessment to inform and direct motivational work as a joint approach working closely with the referrer, normally a care-coordinator (Figure 14). The joint approach assisted in facilitating treatment plans, offering guidance and support to the referrer to continue with the treatment plan following the brief intervention offered within the consultation/ liaison service (Copello et al., 2013). This service offered six sessions (two assessment, two motivational, and two follow- up sessions) conducted over a 12-week period. Initial sessions guided the  development of treatment recommendations, followed by two motivational enhancement sessions and finally two follow up sessions. Motivational sessions focused on understanding their beliefs and reason for substance misuse, strategies to engage with treatment plans and manage mental health symptoms, as well as their associated substance misuse. Follow up sessions were based on the individual’s personal needs however, in general focused on recovery, sustaining positive behavioural change, and building a social network of support. [Figure 14 - Service Delivery Model Approach COMPASS Consultation/Liaison.]

Study Outcomes - The COMPASS service delivery model adopted a short-term brief interventional approach to consultation/liaison providing six sessions followed by a management plan that the referrer followed. This alternative approach to consultation/liaison showed positive outcomes with evidence of improved confidence, a positive change in perspectives on substance use, increased engagement with treatment, reduced alcohol, and cannabis use. The enhancement of existing services through specialist assessment, advice, and consultation supported by the delivery of a brief intervention was attributed to the success of the model (Copello et al., 2013). From a primary care perspective although the COMPASS model was tested with mental health services there is potential to extend this to GP and primary care services. The key enabler is the availability of a practitioner in specialist mental health and a care-coordinator to work with the consultation/liaison service with additional opportunities to link with a collaborative care model as a stepped approach to care (Meadows et al., 2007). For example, supporting people with concurrent addiction and mental health diagnoses to transition back into primary care from community mental health services, and reduce the risk of relapse and support remission (Meadows et al., 2007). This is in addition to a pathway from GPs offering an alternative treatment option within consultation/liaison approach to avail of brief interventions as detailed in the COMPASS programme (Copello et al., 2013)...