Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis

Carol Harvey; Tessa-May Zirnsak; Catherine Brasier; Priscilla Ennals; Justine Fletcher; Bridget Hamilton; Helen Killaspy; Peter McKenzie; Hamilton Kennedy; Lisa Brophy

doi:10.3389/fpsyt.2023.1259944

Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis

Front Psychiatry. 2023 Sep 14:14:1259944. doi: 10.3389/fpsyt.2023.1259944. eCollection 2023.

Authors

Carol Harvey^{1

2}, Tessa-May Zirnsak³, Catherine Brasier³, Priscilla Ennals⁴, Justine Fletcher⁵, Bridget Hamilton⁶, Helen Killaspy^{7

8}, Peter McKenzie⁹, Hamilton Kennedy⁶, Lisa Brophy³

Affiliations

¹ Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
² North West Area Mental Health, Division of Mental Health, Northern Health, Melbourne, VIC, Australia.
³ Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia.
⁴ Neami National, Preston, VIC, Australia.
⁵ Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
⁶ Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia.
⁷ Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom.
⁸ Camden and Islington NHS Foundation Trust, London, United Kingdom.
⁹ The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Brunswick, VIC, Australia.

Abstract

Objective: This study aims to assess the effectiveness of community-based models of care (MoCs) supporting the recovery of individuals who experience persistent and complex mental health needs.

Method: We conducted a systematic review and narrative synthesis of MoC studies reporting clinical, functional, or personal recovery from October 2016 to October 2021. Sources were Medline, EMBASE, PsycInfo, CINAHL, and Cochrane databases. Studies were grouped according to MoC features. The narrative synthesis was led by our researchers with lived experience.

Results: Beneficial MoCs ranged from well-established to novel and updated models and those explicitly addressing recovery goals and incorporating peer support: goal-focused; integrated community treatment; intensive case management; partners in recovery care coordination; rehabilitation and recovery-focused; social and community connection-focused; supported accommodation; and vocational support. None of our diverse group of MoCs supporting recovery warranted a rating of best practice. Established MoCs, such as intensive case management, are promising practices regarding clinical and functional recovery, with potential for enhancements to support personal recovery. Emerging practice models that support personal and functional recovery are those where consumer goals and priorities are central.

Conclusion: Evidence for established models of care shows that there is a need for inevitable evolution and adaptation. Considering the high importance of effective MoCs for people experiencing persistent and complex mental health needs, further attention to service innovation and research is required. Greater emphasis on the inclusion of lived and living experience in the design, delivery, implementation, and research of MoCs is needed, to enhance MOCs' relevance for achieving individual consumer recovery outcomes.

Keywords: community; complex; mental illness; models of care; recovery.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The previous iteration of this review was funded by the Royal Commission into Victorian Mental Health services. This update of the initial review did not receive funding.