Mental disorders affect 38.2% of the EU population. To reduce this burden, throughout Europe, countries are seeking to improve the organization of mental health care with often radical reforms. These reforms are associated with far reaching changes for the national health care systems and consume large amounts of funding. Yet, the reforms are inconsistent, and all policies are currently made in the absence of any sound scientific evidence.
These reforms and the related ongoing debate focus on one central and controversial issue: should systems of mental health care be functional or integrated?
In functional systems, different clinicians and teams are responsible for inpatient and outpatient care.
In integrated systems, the same clinician(s) is/are responsible for both the inpatient and outpatient care of a given patient.
So far, there is no sound research evidence to inform this debate, which has far reaching policy implications.
The COFI project is carrying out a large-scale comparison of functional and integrated systems of mental health care in the following 5 European countries: Belgium, Germany, Italy, Poland and United Kingdom.
Integrated and functional systems co-exist in these five countries. This provides a unique opportunity to compare the effectiveness of both systems, independently of country specific context.
The COFI project team is a multi-disciplinary group of researchers that will prospectively follow-up more than 5000 patients with severe mental disorders over a 1 year period.
We are comparing the effectiveness and cost-effectiveness of both systems with regards to clinical and social outcomes (including quality of life and social contacts), satisfaction with care, and safety, and quality of mental health care provided. In-depth interviews with patients’ and clinicians about their experiences of receiving/providing care within these systems are also being carried out. Policies and legislative frameworks determining relevant practice are currently being identified and assessed.
COFI project aims to produce guidelines for policies specifying the context in which, and the patient groups for which, functional or integrated systems are preferable, and to disseminate these guidelines to governments, scientific societies, professional bodies, and user/carer organisations.