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Comparing policy framework, structure, effectiveness and cost-effectiveness of functional and integrated systems of mental health care (COFI)

Centre for Psychiatry

Funding Body: European Commission (Directorate General for Research and Innovation)
Project Investigator: Stefan Priebe


Countries across Europe are engaging in costly re-organizations of mental health care systems, focused on one controversial core question, i.e. whether mental health systems should be functional or integrated. In functional systems, in- and out-patient care are coordinated by different teams in different services, while in integrated systems the same teams are responsible across services.

The COFI project, led by the Unit for Social and Community Psychiatry, will conduct a large-scale comparison of integrated and functional systems in 5 countries (Belgium, Germany, Italy, Poland, United Kingdom) where both systems coexist.

Activities & outputs

We performed a systematic review of the existing evidence [1] finding a number of limitations:

  • Studies conducted only in local settings and samples and not large enough to detect small effect sizes in differences;
  • Concepts of integrated and functional systems were not consistently defined across the studies;
  • Possible biases towards the new implemented systems.

The COFI project will prospectively assess more than 5000 patients with major mental disorders over a 9 month period. The effectiveness and cost-effectiveness of the two systems will be compared. We will assess clinical and social outcomes (including quality of life), patients' health and social needs, safety and quality of care of patients.

We will also investigate patients' and clinicians' experiences in the two systems and identify the policies and legislative frameworks determining practice. The total duration of the project will be four years [2].

COFI represents a new approach of high quality research on mental health care systems. It will produce clear indications for policy decision-making on mental health care and guide the re-organization of services on the basis of empirical data. The findings will also generate evidence on how to tailor services to the needs of specific populations (e.g. older patients, patients with different diagnoses) and on how to maximize satisfaction of patients with care and their quality of life.

The impact on mental health policies at a European level and at national levels will be maximized by the development of guidelines for policy decision-making based on study findings. Other dissemination methods will include: production of scientific papers, use of popular media and new technologies, contacts with relevant agencies in all European countries and workshops for policymakers, user/carer organisations and mental health professionals.

The COFI project is funded by the European Commission (Directorate General for Research and Innovation) (Ref: FP7-HEALTH-2013-INNOVATION-1, No 602645-2)

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