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Fuller, JD, Perkins, D, Parker, S, Holdsworth, L, Kelly, B, Roberts, R, Martinez, L & Fragar, L 2011, 'Building effective service linkages in primary mental health care: a narrative review part 2', BMC Health Services Research, vol. 11, no. 1, pp. 66-74.

© 2011 Fuller et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (, which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.

Published version available from: http://dx.doi.org10.1186/1472-6963-11-66

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Background: Primary care services have not generally been effective in meeting mental health care needs. Thereis evidence that collaboration between primary care and specialist mental health services can improve clinical andorganisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objectiveof this study was to examine the factors that enable effective collaboration between specialist mental healthservices and primary mental health care.

Methods: A narrative and thematic review of English language papers published between 1998 and 2009. Anexpert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative designfrom Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reportedas enablers or barriers to development of service linkages. These were tabulated by theme at clinical andorganisational levels and the inter-relationship between themes was explored.

Results: A thematic analysis of 30 papers found the most frequently cited group of factors was “partnershipformation”, specifically role clarity between health care workers. Other factor groups supporting clinical partnershipformation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At theorganisational level a supportive institutional environment of leadership and change management was important.The expert reference group then proposed strategies for collaboration that would be seen as important,acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings areweighted by the number of studies. Variability in local service contexts limits the generalisation of findings.

Conclusion: The findings provide a framework for health planners to develop effective service linkages in primarymental health care. Our expert reference group proposed five areas of strategy for policy makers that addressorganisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervisionand feedback.

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