A collaborative primary and mental health care model with psychologist and psychiatrist working in GP practices: Process evaluation of the implementation, challenges, and sustainability

Background Previous studies have shown that collaboration between primary care and mental health services can enhance accessibility and improve outcomes for patients seen in general practitioners (GPs’) office. There is, however, a lack of empirical evidence regarding the benefits of collaborative care in Norway. This study, part of a larger research project, examined the adaptation and implementation of a successful Canadian collaborative care model developed in Hamilton, Ontario, in three Norwegian GP practices located in different boroughs of Oslo, Norway's largest city. Aims To evaluate the required adaptations, implementation, challenges, and sustainability of the Hamilton model within the Norwegian context. Methods The overarching study was a cluster-randomised trial testing the adapted model in three urban GP practices over an 18-month period, with three additional GP practices from the same boroughs serving as control groups. Each intervention site included a half-time clinical psychologist from the local community mental health centre and a psychiatrist who visited for two hours each week. The project also aimed to extend collaboration to other health and community services within each borough. This paper evaluates the implementation of the project's intervention arm, using inductive thematic analysis of documents from all of the project’s phases and following recommendations for process evaluation of complex interventions. Results The model's core component—collaboration between GPs and mental health specialists—was successfully implemented. Participating GPs appreciated the convenient access to mental health specialists to assist with managing mental health problems, although they faced challenges in finding time for collaboration. However, health policy restrictions on providing financial support for co-located collaborative care rendered the model unsustainable beyond the trial period and impeded its expansion to further GP practices. Conclusions The model was successfully implemented and viewed as an improvement in healthcare delivery. If such a model is to be sustained, adjustments must be made to align it with available resources, and reimbursements are needed for collaborative activities in GP practices. It also requires a recognition by funders and planners of the benefits of co-locating specialised mental health specialists within GP practices.