Five-Year Mental Health Care Use by Patients Referred to Collaborative Care or to Specialized Care

Objective: This study compared long-term use of mental health care by two groups of patients who had common mental disorders in the Netherlands-those treated in a collaborative care setting and those referred to off-site specialized mental health services if indicated. Methods: The study was a retrospective analysis of use of mental health care over five years by 139 patients who participated in a cluster-randomized parent study. The parent study involved 27 general practitioners (GPs) who provided either collaborative care or usual care. In the collaborative care condition, a mental health professional worked on site at the GP's practice and was available to provide short-term treatment. In the usual-care condition, the GP referred the patient to off-site specialized mental health services if indicated; if not indicated, the GP provided usual care. The two treatment groups were compared on the number of mental health care contacts and total treatment duration, the proportion that initiated a new treatment episode after termination of the initial treatment, and time to new treatment. Results: Patients in the collaborative care condition received about half the number of mental health care contacts as those in the usual-care condition, and no differences were found in the rate of initiation of new treatment episodes after initial treatment, time to new treatment, and total treatment duration. Conclusions: Referral of patients with common mental disorders to collaborative mental health care as a first intervention led to fewer contacts with a mental health care professional over the long term, compared with referral to specialized mental health care.