The appropriate monitoring of patients on lithium therapy has been the subject of extensive research in the form of clinical audits and surveys culminating in the development of specific guidelines to help clinicians provide optimal care for patients on lithium. The concept of ‘shared care’ has also gained attention in the literature with various types of shared care interventions being introduced as potential ways of improving communication between primary and secondary care.

This article aims to (1) review the literature evaluating lithium monitoring practices in the United Kingdom and Ireland in the last 25 years and (2) determine whether locally agreed shared care agreements have the potential to improve monitoring quality.

A literature search was conducted using the following databases: PubMed, Scopus, Web of Science, Academic Search Premier, CINAHL and PsychInfo. A total of 12 studies were selected for review including 11 audits/prospective chart reviews and one qualitative study using semi-structured interviews.

Overall, the quality of lithium monitoring seems to be improving throughout the years. However, none of the studies reviewed revealed complete adherence to monitoring guidelines. This may be due to a lack of effective communication between primary and secondary care. Several shared care interventions have been described in the literature but there is a paucity of studies concerned with the effects of local shared care arrangements designed for the specific purpose of lithium monitoring. Nonetheless, the extant data suggests that such agreements may help improve monitoring standards by allowing the responsibilities for managing the prescribing and monitoring of lithium to be more clearly defined and shared between primary and secondary care.

Maternal mental health problems affect up to 20% of women, with potentially deleterious effects to the mother and family. To address this serious problem, a Maternal Mental Health Program (MMHP) using a shared care approach was developed. A shared care approach can promote an efficient use of limited specialized maternal mental health services, strengthen collaboration between the maternal mental health care team and primary care physicians, increase access to maternal mental health care services, and promote primary care provider competence in treating maternal mental health problems.

The purpose of this research was to evaluate the impact of a MMHP using a shared care approach on maternal anxiety and depression symptoms of participants, the satisfaction of women and referring physicians, and whether the program met the intents of shared care approach (such as quick consultation, increased knowledge, and confidence of primary care physicians).

We used a pre and post cross-sectional study design to evaluate women’s depression and anxiety symptoms and the satisfaction of women and their primary care health provider with the program.

Depression and anxiety symptoms significantly improved with involvement with the program. Women and physicians reported high levels of satisfaction with the program. Physician knowledge and confidence treating maternal mental health problems improved.

Shared care can be an effective and efficient way to provide maternal mental health care in primary health care settings where resources are limited.