PARTNERS2: development and pilot trial of primary care based collaborative care for people with serious mental illness

Patient and Public Involvement Patient and public involvement is central to our research and its success. Our co-produced research questions arose from mutually perceived needs. We will work with a range of service user organisations to ensure we stay focused on the realities of living with a serious mental illness. Aims and Objectives We aim to develop and trial an innovative primary care based model of collaborative care for people with schizophrenia or bipolar disorder. Collaborative care is a system of delivering care which includes a case manager working in, and in collaboration with primary care, under specialist supervision, providing a platform for appropriate evidence based interventions. Background and rationale Schizophrenia or bipolar disorder are relatively common, costly to the economy and health service and have serious consequences for the individual including poor health and social outcomes. There is strong evidence of patient and carer concern about current services, particularly for those with enduring but stable disorders in secondary care. While there is good evidence to support intensive community services (e.g. assertive outreach), there is less evidence to support the large numbers of individuals who need lower intensity care being managed by community mental health teams (CMHTs). Whilst diet, lack of physical activity, smoking and drug side effects all lead to poor outcomes, problems related to organisation of services and quality of individual care also contribute. Based on our preparatory Cochrane review and extensive audit of current care, PARTNERS2 seeks to improve care through developing collaborative care in primary care for the estimated 73% of people with schizophrenia or bipolar disorder who are currently seen and treated in primary care alone, or in a limited way by CMHTs. PARTNERS2 would be the first research programme focused on collaborative care for people with schizophrenia or bipolar disorder in an English context. This is of major NHS significance given the unplanned way in which people are being discharged from secondary services to reduce short term costs. Research Environment PARTNERS2 represents a collaboration between four leading Universities and is strongly supported by research networks and Clinical Commissioning Groups and Mental Health Trusts in Birmingham, Manchester and South Devon. Research plan In Phase 1, we will develop and refine the model of care and select outcome measures. In Phase 2, we will examine whether the model can be delivered as intended. WS1 will describe current care, help identify who would most benefit from the collaborative care and assess potential risk and safety issues through a retrospective observational cohort study of 300 people and focus groups with service users and carers. WS2 will develop an agreed standardised set of outcomes for use in mental health trials involving people with schizophrenia or bipolar disorder in a community based setting, and the measures to be used in our pilot trial. We will use focus groups with key stakeholders, a Delphi process, systematic review and stated preference technique. WS3 will define and develop the key components of collaborative care through an iterative development process involving up to 150 service users in 12 practices, carers, health professional and managers in our three sites, using a range of qualitative and quantitative data. WS4 will to test the feasibility of patient and practice recruitment and of commissioning the model of care through qualitative work and patient and practice structured surveys.WS5 will draw the findings of the previous four WSs together into a pilot trial protocol and process evaluation. WS6 is a pilot cluster randomised controlled trial and process evaluation involving 60 practices and 300 people in our three localities. Dissemination & projected outputs Dissemination will occur throughout the study to patients and carers, practitioners, planne