Psych CASC / OSCE · Public and community psychiatry — collaborative care and primary care
Explain collaborative care to a GP practice team — CASC communication station
MRCPsych/FRANZCP-style communication station: explain CoCM principles, roles, measurement-based care, evidence highlights, and escalation, in plain professional language.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes. You are the psychiatry registrar invited to the practice clinical meeting. [1]
Candidate instructions. Explain collaborative care versus co-location, the three roles, measurement with PHQ-9, caseload review, evidence in plain terms (IMPACT/Cochrane/TEAMcare), and when patients still need crisis or specialty care. Check understanding and agree next steps. [1][2][3]
Candidate scenario
The practice has a counsellor on Tuesdays. GPs say: "We already do integrated care." Many patients get one antidepressant script and are lost to follow-up. They ask whether collaborative care is just more bureaucracy, and whether a psychiatrist must see every patient face-to-face. [1]
Marking domains
- Professional alliance with primary care colleagues
- Clear definition of CoCM vs co-location
- Three roles explained without jargon overload
- Measurement-based care and item 9 safety
- Evidence highlights (not overclaiming)
- Escalation criteria honesty
- Shared next steps / checks understanding [1][2][3]
Reveal assessor key
Open. Thank them; acknowledge current counsellor is valuable access; name the gap: follow-up intensity and non-responders falling through. [1]
Define CoCM. "Collaborative care is a team system: you, a care manager who tracks the whole list of people with depression/anxiety, and a psychiatrist who regularly reviews people not improving — driven by repeated symptom scores, not one-off visits." [1]
Not bureaucracy for its own sake. "Trials like IMPACT and systematic reviews show better depression and anxiety outcomes than usual care when those pieces are in place." [1][2]
Psychiatrist role. "I do not need to personally assess every mild case. We use caseload review so specialist time focuses on non-responders and complex or high-risk patients; you keep the ongoing relationship." [1]
PHQ-9. "A short nine-item score helps us see severity and change over time. If question nine about death or self-harm is positive, we always do a proper risk assessment the same day." [3]
Multimorbidity hook. "For people with diabetes or heart disease plus depression, similar team models have improved both mood and medical targets." [4]
Escalation. "Active suicide plans, psychosis, or mania still go to crisis/specialty same day — collaborative care is not a waiting room for emergencies." [1]
Close. Propose pilot: registry of 30 patients, fortnightly care-manager measures, monthly caseload review with you; review outcomes in 3 months. Invite questions. [1]
References
- [1]Unützer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial JAMA, 2002.PMID 12472325
- [2]Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and anxiety problems Cochrane Database Syst Rev, 2012.PMID 23076925
- [3]Kroenke K, Spitzer RL, Williams JB The PHQ-9: validity of a brief depression severity measure J Gen Intern Med, 2001.PMID 11556941
- [4]Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses N Engl J Med, 2010.PMID 21190455