Defragmenting mental healthcare
Costs, consequences, and equity effects of integrating mental health into primary care
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About the project
Mental and physical healthcare are often delivered through separate parts of the healthcare system. This fragmentation can lead to gaps in continuity, delayed treatment, and difficulties coordinating care.
This project examines what happens when mental health services are more closely integrated into primary care. The aim is to understand whether better coordination improves access and continuity - and whether these benefits outweigh potential losses in specialization.
Why this matters
Since the 2010s, Sweden has expanded the role of mental health professionals in primary care. Bringing mental and physical healthcare closer together could allow patients to receive support earlier, improve information sharing, reduce reliance on medication, and prevent some patients from requiring specialist care.
But integration can also create new challenges. Referral thresholds may become less clear, quality may vary between clinics, and limited resources could potentially be diverted away from patients with the greatest needs.
The central question is therefore not simply whether healthcare should become more integrated, but how healthcare should be organized when both coordination and specialized expertise are essential.
What we are studying
The project will examine how the integration of mental health services into primary care affects:
- Treatment decisions, including psychosocial and pharmaceutical treatment.
- Access to care, adherence, and continuity.
- Use of specialist and hospital care.
- Patients’ connection to the labor market.
- Total healthcare costs and how costs move between different parts of the system.
- Differences in outcomes according to patient needs and socioeconomic background.
Research design
The project will link Region Stockholm primary care records with national register data on prescriptions, specialist care, labor market activity, and socioeconomic characteristics.
Researchers will use the gradual introduction of mental health services across primary care clinics to study the system-wide effects of greater integration.
Research team
- Project leader: Shan Huang, Postdoctoral Researcher, Stockholm School of Economics.
- Academic advisor: Erik Hedman-Lagerlöf, Professor of Psychology, Karolinska Institutet and Gustavsberg University Primary Care Center.
Status
Ethics approval has been obtained and register data preparation is underway.