Evaluation of a Collaborative Mental Health Care System

Overview

In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care. This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for General Practitioners (GPs) by pooling the 48-hour supply of psychiatric consultations in real time. It is assumed that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders. This study main objective is to compare the proportion of patients with a psychiatric disorder who will receive outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).

Detailed description

General practitioners (GPs) are the gateway to the healthcare system and therefore the first point of contact for mental health. A significant proportion of psychiatric disorders can be treated in primary care if GPs have easy access to psychiatric support. However, they are faced with difficulties in accessing secondary care. Around 9/10 consider that it is more difficult to obtain specialist advice than for other disciplines, and say they have difficulty referring a patient for mental health care.

In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care. It is recognized that the deployment of earlier and more graduated care reduces the intensity of disorders, prescriptions for time off work and psychotropic drugs, and hospitalizations.

A new, more preventive, efficient and cost-effective approach to mental health is emerging, with psychiatrists working closely with GPs. This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for GPs by pooling the 48-hour supply of psychiatric consultations in real time. We assume that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.

This study main objective is to compare the proportion of patients with a psychiatric disorder who will received outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).

Interventions

• Other Clinical assessment by emergency psychiatrist
  After a clinical assessment by the emergency department psychiatrist which does not lead to hospitalization, the patient will be given a psychiatric interview and sent home.
• Other Psychiatric consultation booked through Med@Psy platform
  The patient will be seen within 48 hours after the consultation with his or her general practitioner by a psychiatrist taking part in the study.

Primary outcome measures

• Number of patients with a consultation with a psychiatrist, a psychologist or a general practioner one month after the consultation via the med@psy system or the visit to emergency department [Time frame: 1 month]

Secondary outcome measures (7)

• Outpatient follow-up at three months [Time frame: 3 months]
• Medical partners commitment (part 1) [Time frame: 1 year]
• Medical partners commitment (part 2) [Time frame: 1 year]
• Medical partners commitment (part 3) [Time frame: 1 year]
• Medical partners commitment (part 4) [Time frame: 1 year]
• Med@psy platform patients characteristics [Time frame: 1 month]
• Functioning Global Assessment [Time frame: 3 months]

Eligibility criteria

Inclusion criteria

• Patient ≥ 18 years ;
• Patient presenting to the Centre hospitalier de Toulon La Seyne sur Mer emergency department, with or without referral, and receiving psychiatric advice with discharge without hospitalization after clinical assessment (Group 1) or patients referred for psychiatric consultation via the Med@psy system (Group 2).
• Patient with indication for outpatient follow-up
• Patient with open social security rights

Exclusion criteria

• Patient's refusal to take part in research ;
• Patient currently being followed by a psychiatrist. Psychiatric follow-up is defined as at least one consultation with a psychiatrist in the last 3 months, outside an unscheduled care consultation or in an emergency department;
• Patients referred for a suicide attempt, violent or non-violent, serious or non-serious;
• Patients without a declared general practioner;
• Patients already included in the study;
• Patients who do not speak French;
• Patients under judicial protection (guardianship, curatorship, etc.) or safeguard of justice;
• Patient under compulsory care, under a care order or deprived of liberty.
• Any other reason which, in the investigator's opinion, could interfere

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

France · 2 centers

• Cabinet médical Korrichi (Med@psy program linked to this office) — Toulon
• Centre Hospitalier Intercommunal Toulon La Seyne sur Mer emergency reception service — Toulon

Publications

• Truelove S, Ng V, Kates N, Alloo J, Sunderji N, Patriquin MJ. Les soins de sante mentale en collaboration: Mobiliser les systemes de sante pour soutenir une approche d'equipe. Can Fam Physician. 2023 Feb;69(2):86-88. doi: 10.46747/cfp.690286. No abstract available. French. PMID 36813512
• Jones SH, Thornicroft G, Coffey M, Dunn G. A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). Br J Psychiatry. 1995 May;166(5):654-9. doi: 10.1192/bjp.166.5.654. PMID 7620753
• Kates N, Arroll B, Currie E, Hanlon C, Gask L, Klasen H, Meadows G, Rukundo G, Sunderji N, Ruud T, Williams M. Improving collaboration between primary care and mental health services. World J Biol Psychiatry. 2019 Dec;20(10):748-765. doi: 10.1080/15622975.2018.1471218. Epub 2018 Jun 20. PMID 29722600
• Dias Alves M, Jobic A, Rosso N, Abello M, Autret A, Vion-Dury J, Belzeaux R, Korrichi F. Evaluation of a collaborative care system in primary care in the implementation of ambulatory follow-up in mental health: A study protocol. PLoS One. 2026 Feb 25;21(2):e0343295. doi: 10.1371/journal.pone.0343295. eCollection 2026. PMID 41739822

Identifiers

NCT: NCT06581874 · 2024-CHITS-005 · 2024-A01115-42

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗