Coordinating Mental Health Services for People with Serious Mental Illness: A Scoping Review of Transitions from Psychiatric Hospital to Community


Effective coordination as people with serious mental illness (SMI) move between care settings is essential. We aimed to review challenges to care coordination for people with SMI and identify approaches for improving it. Sixteen articles were identified. Two main challenges emerged: people with SMI facing adjustment challenges during transitions and services struggling to provide continuity of care. Effective approaches addressed coordination challenges and resulted in better improvements in service utilization, social functioning and quality of life. Future interventions may benefit from shared decision-making, support for caregivers, and addressing the challenges associated with complicated medication regimes and accessing medications.

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The authors express gratitude to Thomas L. Mead, retired Reference Librarian, Dartmouth Institute for Health Policy and Clinical Practice for performing the systematic literature searches.


First author 2017–2018 Harkness fellow Marianne Storm received support for this research by the Norwegian Research Council Grant Agreement No. 276638 and The Commonwealth Fund. The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.

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Correspondence to Marianne Storm.

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This scoping review article does not contain any studies with human participants performed by any of the authors.

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See Tables 4, 5.

Table 4 Quality assessment qualitative research designs
Table 5 Quality assessment quantitative research designs

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Storm, M., Husebø, A.M.L., Thomas, E.C. et al. Coordinating Mental Health Services for People with Serious Mental Illness: A Scoping Review of Transitions from Psychiatric Hospital to Community. Adm Policy Ment Health 46, 352–367 (2019) doi:10.1007/s10488-018-00918-7

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  • Care coordination
  • Continuity of care
  • Care transitions
  • Serious mental illness
  • Scoping review