Collaborative therapy: framework for mental health

We agree with the sentiments expressed by Lester & Gath (2006) in their recent editorial on promoting a collaborative model of recovery, and believe that the collaborative therapy model which we have developed goes some way towards meeting the need for ‘a collaborative approach… to the development of high-quality recovery-oriented mental healthcare’.

One of the key aspects of collaborative therapy is recognising that ‘recovery’ and chronic models of healthcare are not dichotomous. Recovery is an individual process that can be assisted through the application of a model of care embracing the reality of mental illness and encompassing both the management of acute episodes and long-term health needs.

Collaborative therapy is a comprehensive therapeutic framework for consumers, clinicians, services and others to work systematically towards the achievement of optimal mental health outcomes. The aim is to deliver, within mainstream services, comprehensive psychosocial treatments that are evidence-based and individually tailored. The ability to individually tailor treatments thus allows for the incorporation of personal definitions of recovery.

The collaborative therapy framework has three components that can be applied across the spectrum of mental disorders. Engagement encompasses a comprehensive screen for issues that may be barriers to treatment (including psychiatric comorbidity), as well as a mapping of ‘collaborative partners’, who agree to be involved in the individual's care. These may include the general practitioner, case manager, psychiatrist, vocational worker and family members. All collaborative partners are explicitly involved in the planning of healthcare for the individual.

The therapy itself can be conducted in a group or one to one with a case manager. It is run over 8–12 weeks, followed by booster sessions over a further 9 months, is based on an adaptation of the stress vulnerability model (stress vulnerability–self efficacy) and utilises self-efficacy and self-reliance as part of the process. It provides core components of the therapeutic interventions that have established efficacy across a wide range of diagnosis, including psychoeducation, coping and relapse prevention strategies. An allied tool is the collaborative treatment journal, a small pocket journal that can chart stressors, early warning signs, coping strategies, supports and other factors that influence the course and management of an individual's health. It is held by the consumer and places them at the centre of their treatment.

The unique appeal of the collaborative therapy framework is that it is sensitive to the structure, resources and staff-mix of particular services, and meets all consumers’ needs. This helps to ensure that there is maximum likelihood that the components developed within the collaborative therapy framework are taken up within routine service delivery structures. It has been adopted by a number of Australian mental health services, and is well accepted by consumers, their families, and health professionals.