Integrated care programmes for severe mental illnesses and comorbid physical health disorders: the EU-MIND umbrella review to inform future actions in Europe.

内容摘要

People with severe mental illness (SMI) represent up to 6% of the population and experience a high burden of physical comorbidity and premature mortality. Despite longstanding international calls to develop integrated care, the optimal organisational approaches for this population remain poorly defined, and health systems lack guidance on how to redesign care pathways. This review aimed to characterise the core components, reported impacts, and implementation challenges of existing integrated care programmes for individuals with SMI and physical health conditions. This umbrella review was reported in accordance with the PRISMA 2020 and PRIOR statements. PubMed, Scopus, PsycINFO, and Cochrane were initially searched from inception to February 2025, with an updated search performed on 5 May 2026, for review studies of integrated care programmes for people with SMI and comorbid physical conditions or social vulnerabilities. Methodological quality was appraised using AMSTAR-2, and the most mature programmes were synthesised narratively using the SELFIE framework for multimorbidity-oriented integrated care. The review was registered on OSF (https://osf.io/se2u4). Seventeen review studies met the inclusion criteria, identifying 20 distinct integrated care programmes. Although heterogeneous, these programmes most commonly integrated physical healthcare within mental health services, relied on case managers, and emphasised proactive, individualised, and continuous care. Coordination with social care services and involvement of service users in programme design was limited. Governance and financing arrangements were weak, the use of digital tools was scarce, and effects on physical health and social outcomes remained modest. Evidence on effective and scalable integrated care programmes for people with SMI and physical comorbidity remains limited. These findings inform the next phase of the European Mental and Physical Health Initiative for People with Severe Mental Disorders (EU-MIND), which will use a Delphi process with key stakeholders to guide the implementation of sustainable integrated care across diverse European health systems. This study was funded as part of the EU-MIND initiative under the 2024 European Partnership on Transforming Health and Care Systems (THCS).