GENERAL PRACTITIONERS (GPs) are often the first point of contact for people experiencing mental health difficulties, managing a greater proportion of patients with these conditions than specialist services. Evidence shows that early GP intervention and continuity of care are linked with fewer hospital admissions, reduced demand for out-of-hours services, lower mortality and less strain on specialist providers. Yet GPs face challenges in recognising mental disorders, particularly when these occur alongside physical health problems, while also managing heavy workloads and financial responsibilities.
One approach to addressing these difficulties is collaborative care, where GPs and mental health professionals work closely together, sharing expertise and resources. The Hamilton Family Health Team (HFHT) model, established over 30 years ago in Ontario, Canada, provides a well-tested example. It brings together family physicians, nurses, counsellors, psychiatrists and allied health professionals in co-located teams, ensuring accessible and comprehensive care close to patients’ homes. Evaluations have shown wide benefits, both for patients and for service providers.
Inspired by this model, Norwegian researchers tested an adapted version within local GP practices. Each practice hosted a half-time psychologist and a visiting psychiatrist, working alongside three to four GPs. The co-location of professionals and the psychologist’s role as first point of contact proved particularly valuable, allowing swift assessments, short-term therapy, and collaborative decision-making. GPs reported enhanced skills and confidence, while patients benefited from earlier intervention and more coordinated care.
However, the study also highlighted barriers. Chief among these was Norway’s split funding system, which does not reimburse collaborative activities between primary and specialist services. This structural issue undermines efforts to reduce fragmentation, despite national policies aiming to strengthen integration. Additionally, limited involvement of patients, families and municipal service providers in planning and implementation restricted the model’s reach.
Overall, the project demonstrated that adapting the HFHT approach in Norway is both feasible and beneficial, but long-term sustainability will require financial reforms and broader stakeholder engagement. By aligning funding with policy goals and encouraging genuine collaboration, Norway, and other health systems, could better support GPs in delivering high-quality, accessible mental health care.
Reference
Ruud T et al. A collaborative primary and mental health care model with psychologist and psychiatrist working in GP practices: process evaluation of the implementation, challenges, and sustainability. BMC Health Serv Res. 2025;25(1):1178.
