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What is collaborative care?

Why is collaborative care needed?

Primary care is not designed to treat mental health conditions.

When you are facing a mental health challenge, like anxiety or ADHD, it's very challenging to take the extra step to ask for help. Most people seek out treatment from their primary care doctors to start. This makes sense since only about half of psychiatrists accept insurance, and out of pocket fees for private psychiatrists are high. People often face many barriers to obtaining healthcare. You may have to wait weeks or months for an appointment with a primary care doctor. When you finally get to see the doctor, it can seem as if your entire life is compressed into a 15-minute interview, where you're assessed, diagnosed, and prescribed a medication. For some, that very first medication may help. However, for many others, the first medication may not feel like it’s working or the medications may cause side effects. The primary care doctor may not have the time or expertise to advise on these issues. The result is inadequate care: wrong diagnoses, wrong medications, and/or wrong doses. 

Access to mental health experts is expensive and disjointed

After moving on from primary care, you begin researching to find a reputable and affordable professional, but soon this feels like an impossible task. It is a struggle to get appointments with the right people. You may find yourself waiting weeks or months to be seen. If you do get treatment, it may feel like the different professionals that you’re working with (e.g psychiatrist, therapist, primary care doctor) don’t talk to each other. Finding good mental health care is so time-consuming, expensive and unsatisfying that many people just give up. Fortunately, the Collaborative Care Model (CCM) was designed to address these deficiencies in our healthcare system and better meet your needs. 

The Collaborative Care Model is an innovative approach to providing mental health treatment by providing easier access to excellent mental health treatment provided by professionals working together as a team. First, evidence based scales are used in combination with an interview to help provide an accurate assessment of what’s going on. Then, medications are used in combination with coaching and problem-solving therapy to help you achieve your goals. In addition, an expert psychiatrist provides oversight to prescribers, and progress is tracked using evidence-based scales to ensure you stay on track. The whole team talks to each other, with much of the care flowing throw a care coordinator (sometimes called a coach) who makes sure that patients are receiving the best care. In over 80 randomized controlled trials the collaborative care model has been shown to deliver better outcomes, lower costs, and healthier patients.

Why are the scales so important?

Your team is going to proactively contact you and monitor your symptoms with evidence-based scales (e.g. PHQ-9GAD-7) to achieve clearly defined goals. This is broadly called Measurement Based Care, and it’s a critical piece of collaborative care. It’s straightforward. You provide feedback about your symptoms to your team. Then, your team can see what’s working and what needs to be adjusted. Research shows that Measurement Based Care improves clinical results, better informs collaborative care efforts, improves clinical decisions and patient engagement in therapy. 

Improved communication between your healthcare providers

If you have ever received care from several doctors (or therapist or other professional) at once, you likely felt at times that not everyone was on the same page. For example, you may have received contradictory information, advice, and recommendations from multiple people. It can feel overwhelming when you don’t know whose advice to follow. What if there was a person whose main responsibility was to ensure that your entire treatment team was on the same page?

These types of situations are all too common and contribute to the inefficiency of our healthcare system. For example, depressed patients take an average of 10 years to get treatment after their symptoms start, while 70% of them never receive adequate care (source: WHO). This should never be the case, and is an important motivation for collaborative care.

How does collaborative care work?

A team-based approach is the cornerstone of collaborative care (hence the term collaborative).  This means all of your professionals are working together to build you the most effective treatment plan.  This saves you time, avoids the frustration of repeated assessments, and most importantly provides the most comprehensive care with the best outcome, all while saving you money.

Your team may include:

  1. Yourself – You are the most important part of your team. During traditional treatment, you may feel that your voice is not being heard. However, in collaborative care, your input and feedback are an essential part of the model.
  2. Care manager - Your care manager is your coach. They have various forms of training and may include counselors, psychologists, or social workers. They manage your overall treatment plan, provide you with brief psychotherapy, support your medication management, and orchestrate the communication with the rest of the team.
  3. Prescriber - A licensed professional manages the medications. This may be a primary care physician or nurse practitioner. They often start people on medications if needed. They will follow up with you to check your progress and collaborate with your coach.
  4. Psychiatric consultant - Your psychiatric consultant will provide guidance to the coach and prescriber regarding any mental health issues, helping to troubleshoot any challenges that come up along the way.

Does it really work?

It might sound good, but are you wondering if it actually works? Over the past 20 years, more than 80 peer-reviewed scientific studies have been published and consistently showed that collaborative care is more effective than standard psychiatric approaches for the treatment of several psychiatric conditions, including depression, anxiety, and ADHD. One such study that tracked patients for two years found that the use of collaborative care over traditional care was more effective for patients with anxiety. The improvement in care was notable as early as the first month into the study and lasted throughout. Another study shows the benefits of online collaborative care in treating anxiety and mood disorders, and that it can be superior to in-person care from a primary care physician. 

This has been further proven by meta-analyses that dug into literature to show how several tens of thousands of patients have benefited from CCM in terms of improvement of symptoms, quality of life, and decrease of costs. Despite the scientific evidence, CCM and most other integrated care models have not been widely adopted, though more and more providers (especially large academic medical centers) are turning to CCM. The growing presence of telemedicine and digital mental health care will hopefully prove to be a major catalyst for proving the effectiveness of this therapeutic approach.

If you're interested in more information on collaborative care visit the University of Washington AIMS website. The University of Washington helped pioneer the concept of collaborative care.