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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - RECOVER-E (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE)

Teaser

Summary

For nearly 900 million people living in Europe, mental disorders constitute the most significant yet neglected public health problem. Community-based services increase life expectancy, quality of life, treatment adherence, and service access. Implementation of services and an evidence base from which to make a case for the scale-up of comprehensive services is limited in Central and Eastern Europe.

RECOVER-E aims to ensure community mental health teams in Croatia, Montenegro, Romania, North Macedonia, and Bulgaria. It will:

1) develop evidence-based care pathways and treatment protocols for transition to scale
2) establish a peer to peer capacity building partnership by linking a European expert panel with key stakeholders to co-create community mental health services
3) evaluate intervention elements through research that will enhance sustainable adoption and implementation of community-based care for people with SMI.

Work performed

RECOVER-E is organised into 7 work packages (WPs).

WP1 (MANAGEMENT AND COORDINATION): Objectives of WP1 are to coordinate project implementation and to manage the project on a day-to-day basis. Completed and ongoing tasks include: finalization of the consortium agreement (signed February 2018), continuous partner coordination and tracking of milestones and deliverables; organizing monthly management team meetings (held the 3rd Wednesday of each month), bi-monthly WP leader calls and two annual in-person Steering Committee meeting (January 2018 and February 2019).

WP2 (NEEDS ASSESSMENT AND FESABILITY ASSESSMENT). This work package is focused on understanding the current situation in mental health care in each of the 5 implementation sites in order to tailor project implementation. Completed activities in this WP include site visits to assess mental health services and catchment areas in all 5 sites; situational analysis of mental health care provision; needs assessments of unmet and met needs among service users, carers and mental health professionals, and locally-tailored implementation plans to concretely guide the implementation of the intervention.

WP3 (IMPLEMENATION). This work package is focused on the implementation of the intervention, which consists of multidisciplinary community mental health teams that deliver evidence-based recovery-oriented care and include peer workers as members of community mental health teams. Community mental health teams were set up as formal entities in each of the 5 sites. The CMHTs in all 5 sites attended local trainings organized by the project team on how to work as a mobile team. The first 3 sites (Croatia, Montenegro, and Romania) attended the second training in the Netherlands to see how community mental health care is administered in practice in May 2019 and have started operating as mobile team(s).

WP4 (RESEARCH EVALUATION) and 5 (ECONOMIC EVALUATION)
The objective of these research Work Packages are to evaluate the effectiveness and implementation process of the intervention through a hybrid implementation-effectiveness trial, as well as evaluate the cost-effectiveness and cost-utility of the intervention compared to usual care in all 5 of the countries. To date, the project team conducted in-country assessments for each of the 5 implementation sites. These activities are part of WP2 but provide data for WP4 and 5 that guide the design of the trial. Each of the 5 sites were trained in implementation research methods in June 2018. All 5 sites have obtained ethical approval to begin the trial, have made necessary logistical arrangements to start the trial. Three of the 5 sites (Zagreb, Kotor, and Suceava) have all started patient recruitment for the trial. Sofia and Skopje are scheduled for trial recruitment in the first part of the subsequent reporting period, as per the research protocol which allows for staggered roll-out of the study across the 5 implementation sites.

WP 6 (BRIDGING THE GAP BETWEEN POLICY AND PRACTICE)
The objective of WP6 is to engage with decision-makers and prepare a pathway for transition to scale, for continued implementation of the intervention after the projectâ€™s life span. In this reporting period, the WP6 leader conducted a stakeholder analysis in each of the 5 sites to better understand which groups and individuals have the power to impact decisions in mental health care in each of the 5 sites. Using the list of stakeholders identified, policy influencing strategies were developed in each of the sites that specify how best to engage with stakeholders in each site.

WP 7 (DISSEMINATION)
The objectives of WP7 are to develop and implement a dissemination plan to raise awareness about project findings and discuss the translatability and applicability of findings. To date, a dissemination strategy was developed and submitted to EC in June 2018, a project website was created (http://www.recover-e.eu) and representatives from 3 consortium partners

Final results

Results of RECOVER-E are expected to have a direct impact on end users, society, practice and policy, and the economy. First, the results are expected to impact end users, defined as people with severe and enduring mental ill health will receive appropriate crisis care where they need it (i.e. at home), according to their needs and preferences; Increased access to integrated mental health and social care in the community. It is anticipated that at a societal level, there will be more inclusion of vulnerable groups through engaging community members as partners in all phases of the design, implementation, and evaluation process of the intervention. : In participating countries of this project policies, while content wise very strong, implementation plans are often not developed, weak, and/or only partially implemented, without corresponding budgetary allocation. Consequently, policies stay on shelves of Ministries. This project changes this by transferring the know-how to implement policy provisions (e.g. community mental health care) and using the lessons generated from the field to lobby with policymakers, leveraged through the projectâ€™s existing partnerships with policy makers in each of these countries. Finally, it is expected project results will positively impact indirect costs of seeking mental health care (i.e. lost or reduced educational, employment, or income-generating opportunities), as a result of fewer hospitalizations and less travel time to psychiatric hospitals required, as well as fewer disruptions in daily life.