Remarks y The CC model generally adds one new team member to the medical team (a care manager) and includes coordinated consultation with mental health care providers. It typically involves:

• a health-care team sharing tasks, with a care manager (a new role) coordinating care;
• approaches to identifying people in need of support (through use of systematic screening or case identification);
• implementation of evidence-based interventions (where psychological interventions can be delivered by the care manager or, where available, by a non-specialist counsellor);
• administration of medicine, if indicated (by a general medical care provider);
• monitoring of mental health symptoms by recording results of measurement tools in a basic registry that is regularly reviewed by the case manager to inform changes to care; and
• a mental health care provider, who consults with the team and supervises the care manager and general medical care provider. y Care managers often also facilitate access to community resources where indicated (e.g. housing or employment services). y Physical health conditions concern both communicable and noncommunicable diseases. y Conditionality in this recommendation is based solely on availability of resources. In settings where resources are available, CC should be implemented. y Integrating mental health services into primary care settings and physical disease programmes through the CC model is an effective way of increasing access to mental health care, improving health outcomes and reducing stigma towards people with mental health conditions, particularly for populations where prevalence of mental disorders (e.g. depression) may be high. y There is wide variation in how CC has been implemented as CC is a model of providing care, rather than an intervention in and of itself. Nonetheless, this model of care can be resource intensive, though it is feasible in LMIC settings when necessary resources are allocated.

Implementation considerations y CC is generally more intensive in terms of human resources than usual care models (although there is evidence to suggest it may provide good economic value). The human resources required for CC vary widely based on how the components of the model are adapted for implementation in a given setting. y CC should only be implemented in settings where there are human resources allocated to support the intervention. y Specific efforts are required to identify, orient and build capacity in medical teams, care providers and mental health care providers for this model of integrated care. y Acceptability of CC can be increased when implementors:

• engage key stakeholders (e.g. service-users, providers, policy-makers, and community members) in the development of the CC model to ensure it will be suitable for the setting in which it is being implemented;
• incorporate trusted community members in the CC team;
• adapt CC training materials, guidelines, and interventions to be culturally appropriate; and
• address lack of understanding of integrated care, understanding of mental health and confidence in delivering mental health care, resistance due to feeling overburdened, stigma or medical hierarchies among providers.