Collaboration between prescribing physicians and psychotherapists in mental health care
- Andrew Skodol, MD
Andrew Skodol, MD
- Section Editor — Personality Disorders
- Research Professor of Psychiatry
- University of Arizona College of Medicine
Patients treated with medication and psychotherapy for a mental disorder may be treated by a single clinician, typically a psychiatrist, or by two clinicians, one prescribing medication and the other providing psychotherapy. Provision of the two modalities by two clinicians is often referred to as “split” treatment, while provision by one clinician is described as “integrated” care.
The prevalence of split mental health care appears to have risen in recent decades. Potential hazards of split treatment can occur when psychotherapy and pharmacotherapy are not well coordinated. They can be avoided if the prescribing physician and the psychotherapist proactively communicate with one another and establish procedures to support an effective collaboration. There are no data from clinical trials comparing the quality or outcomes of care between split versus integrated treatment.
Provision of a patient’s care by two or more clinicians is not unique to mental health care. Care is typically split between primary care and other medical specialists, as well as between physicians and non-medical clinicians such as physical therapists. This topic emphasizes issues encountered in providing mental health care.
This topic describes challenges associated with split treatment, and describes approaches to collaboration under this model of care. Other features of the clinician-patient relationship in mental health care are discussed separately. (See "Establishing and maintaining a therapeutic relationship in psychiatric practice" and "A patient-centered view of the clinician-patient relationship".)
CHARACTERISTICS OF SPLIT CARE
Split mental health care occurs when a patient receives two or more modalities of treatment from two or more clinicians. Split treatment is most commonly delivered by a:
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- CHARACTERISTICS OF SPLIT CARE
- ORGANIZATIONAL FACTORS
- Shared team or setting
- Shared organization
- Independent clinicians
- Models of collaborative care
- POTENTIAL HAZARDS
- APPROACHES TO COLLABORATION
- Waiver of confidentiality
- Initial contact
- Monitoring safety
- Information sharing
- Communication methods
- Contact frequency
- Shared knowledge
- Treatment adherence
- SUMMARY AND RECOMMENDATIONS