H06 – Approaches to Integrate Mental Health Services in Primary Care: A Scoping Review of System-level Barriers and Enablers to implementation

Summary

Despite the growing prevalence of mental illness, the integration of mental health services in primary care has been a persistent challenge in Canada. Successful integration leads to reduced stigma, improved treatment of comorbidities, and enhanced access to care. The objective of this project was to conduct a scoping review investigating system-level barriers and enablers to implementing collaborative care models to integrate mental health services in primary care. MEDLINE, EMBASE, and PsycINFO were systematically searched between May 4, 2020, and May 23, 2020, resulting in the inclusion of 63 articles. Sources were included if the setting was primary care, the intervention involved at least one mental health practitioner collaborating with a primary care provider, the outcome related to barriers and/or enablers to model implementation, and the article type was peer-reviewed. Sources related to pilot projects and health outcomes were excluded. Key article summary characteristics were study origin geography, study objective, care team composition, and target mental condition per model. The Consolidated Framework for Implementation Research was utilized to code and analyze implementation barriers and enablers according to its five domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. The majority of studies were conducted in North America, with models that specialized in the treatment of depression and anxiety. The main themes that emerged from the findings that related to the outer setting included: funding and reimbursement; health practitioner workforce and training; relationships with organizations and communities; and policy development and coordination. Results may inform the scaling up of existing promising local initiatives and pilot projects that integrate mental health services into primary care. Future work should focus on scaling up projects through implementation research and policy evaluations. The rationale for this presentation is to update and enrich the current knowledge base regarding the implementation factors impacting the integration of mental health services in primary care. This project addresses the conference theme particularly in regards to health equity. We believe that increased collaboration and integration between mental and physical health services in primary care results in increased access, and thus more equitable healthcare. The target audience is wide open, and we hope to disseminate our findings to clinicians, researchers, policymakers, and patients and their families. Attendees will learn about the various implementation factors related to the integration of mental health services in primary care and apply these to a variety of jurisdictions.