Mental Health Link: the development and formative evaluation of a complex intervention to improve shared care for patients with long-term mental illness.

AIMS AND
OBJECTIVES: This study aims to develop an intervention and related conceptual framework for developing shared care for patients with long-term mental illness, and to provide a case study of the development of a complex intervention in primary care.
METHODS: A pragmatic iterative design involved a literature review and focus groups followed by a formative evaluation including reflection, questionnaires and interviews. General practices and associated community mental health teams in Southeast London were involved. Participants included community mental health workers, psychiatrists, practice nurses, general practitioners, managers and local experts with an interest in primary mental health care.
RESULTS: The model for shared care includes the core components of improved communication together with the development of a register and database with systems for review and recall. Local needs assessment, audit, training and guidelines are complimentary components. The intervention, Mental Health Link, is a facilitated quality improvement programme which aims to expedite the development of services by bringing the teams together to agree on a model of shared care suited to local needs, skills and interests, and by supporting the development of practice systems.
CONCLUSIONS: A model for shared care needs to take into account interdependencies of the components as well as the relationship with the context. The heterogeneity of primary and community care need to be reflected in the development of complex interventions designed to enhance shared care. It is possible to develop a generalizable complex intervention which is sensitive to local circumstances.