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Across the world mental health services are organised according to different models. In some services the same psychiatrist treats a given patient in hospital and in the community (personal continuity of care) whilst in other services there are different psychiatrists who specialise in either hospital or community settings (specialisation). For a long time, these alternative models of service organisation have been implemented in routine practice without a consistent evidence base.

A European study (COFI) was carried out to provide high quality evidence on which of the two models offers better outcomes and a more positive experience of care for patients. COFI is one of the largest ever prospective studies in mental health care having recruited and followed up more than 7000 patients with severe mental disorders. This study was run in five European countries (Belgium, Germany, Italy, Poland and United Kingdom). In each of these countries both models co-exist and are implemented in different services.

Different research methods were applied, including analyses of medical records, quantitative and qualitative interviews with patients and staff as well as analyses of costs and service use.

This talk will present the findings of the COFI study for the UK context. It will offer a comparison of clinicians and patient views on continuity of care and specialisation as well as the findings on the relative effectiveness of the two models in preventing admissions to hospitals and in favouring better clinical and social outcomes. Finally, findings on costs associated to the two models and on care arrangements supporting continuity or specialization within the UK will be discussed.

It is hoped that the talk will generate a lively discussion regarding how service organisation can foster better outcomes for our patients and what role psychiatrists can play in it.