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Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis

Overview

This systematic review examined community-based mental health models supporting recovery for people with persistent, complex mental health needs. Analysing 59 studies across eight model types, researchers found promising evidence for intensive case management and integrated community treatment, but noted limited focus on personal recovery outcomes and insufficient consumer involvement in research design.

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Individual authors

Lead Authors:

  • Carol Harvey (University of Melbourne & Northern Health, Melbourne)
  • Tessa-May Zirnsak (La Trobe University, Melbourne) - corresponding author

Co-Authors:

  • Catherine Brasier (La Trobe University)
  • Priscilla Ennals (Neami National, Preston)
  • Justine Fletcher (University of Melbourne)
  • Bridget Hamilton (University of Melbourne)
  • Helen Killaspy (University College London & Camden and Islington NHS Foundation Trust, London)
  • Peter McKenzie (La Trobe University)
  • Hamilton Kennedy (University of Melbourne)
  • Lisa Brophy (La Trobe University)

Key insights

Key Insights:

  1. No model achieved "best practice" rating for supporting all recovery types

  2. Personal recovery was primary outcome in only four of 59 studies

  3. Intensive case management showed strongest evidence for clinical/functional recovery

  4. Peer support workers appeared in only 10 studies across models

  5. Consumer co-design was rarely reported in model development or research

  6. Recovery Assessment Scale was most commonly used personal recovery measure

  7. Team-based approaches were predominant across most effective model types

  8. Goal-focused and social connection models showed emerging promise for recovery

Did this resource draw on transformative evidence?

<p>The review team included 4 researchers with lived experience who led the narrative synthesis. However, the 59 underlying studies analysed had minimal consumer involvement - few reported co-design, none were consumer-led, and most lacked meaningful participation from people with lived experience.</p>
<p><strong>Moderate practice wisdom inclusion.</strong> The document synthesised evidence from real-world community mental health services across 20 countries, but was primarily based on published research rather than direct practitioner knowledge. The interdisciplinary team likely brought practice perspectives, though this isn&#39;t explicitly detailed in the methodology.</p>
<p><strong>Heavily based on research insights.</strong> This systematic review analyzed 59 peer-reviewed studies (46 quantitative, 10 qualitative, 3 mixed-methods) from October 2016-2021 across multiple databases. It used rigorous methodology including quality assessment, narrative synthesis, and evidence categorization, representing comprehensive research-based evaluation of mental health models.</p>

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Categories

Resource type

Model of Care

Systematic Review

Translational research priority theme

Community-based models of care