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Continuity of care in mental health: understanding and measuring a complex phenomenon

  • T. Burns (a1), J. Catty (a2), S. White (a2), S. Clement (a3), G. Ellis (a2), I. R. Jones (a4), P. Lissouba (a2), S. McLaren (a3), D. Rose (a5) and T. Wykes (a5)
  • DOI:
  • Published online: 23 June 2008

Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness.


A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care.


Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model.


We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.

Corresponding author
*Address for correspondence: Professor T. Burns, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. (Email:
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CE Adair , GM McDougall , A Beckie , A Joyce , C Mitton , CT Wild , A Gordon , N Costigan (2003). History and measurement of continuity of care in mental health services and evidence of its role in outcomes. Psychiatric Services 54, 13511356.

CE Adair , GM McDougall , CR Mitton , AS Joyce , TC Wild , A Gordon , N Costigan , L Kowalsky , G Pasmeny , A Beckie (2005). Continuity of care and health outcomes among persons with severe mental illness. Psychiatric Services 56, 10611069.

J Bindman , S Johnson , S Wright , G Szmukler , P Bebbington , E Kuipers , G Thornicroft (1997). Integration between primary and secondary services in the care of the severely mentally ill: patients' and general practitioners' views. British Journal of Psychiatry 171, 169174.

RI Cook , M Render , DD Woods (2000). Gaps in the continuity of care and progress on patient safety. British Medical Journal 320, 791794.

M Crawford , E Jonge , G Freeman , T Weaver (2004). Providing continuity of care for people with severe mental illness. Social Psychiatry and Psychiatric Epidemiology 39, 265272.

JL Haggerty , RJ Reid , GK Freeman , BH Starfield , CE Adair , R McKendry (2003). Continuity of care: a multidisciplinary review. British Medical Journal 327, 12191221.

L Heslop , S Elsom , N Parker (2000). Improving continuity of care across psychiatric and emergency services: combining patient data within a participatory action research framework. Journal of Advanced Nursing 31, 135143.

HF Kaiser (1974). Index of factorial simplicity. Psychometrika 39, 3136.

A Kopelowicz , C Wallace , R Zarate (1998). Teaching psychiatric inpatients to re-enter the community: a brief method of improving the continuity of care. Psychiatric Services 49, 13131316.

P McGuffin , A Farmer , I Harvey (1991). A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764770.

CR Mitton , CE Adair , GM McDougall , G Marcouz (2005). Continuity of care and health care costs among persons with severe mental illness. Psychiatric Services 56, 10701076.

KT Mueser , GR Bond , RE Drake , SG Resnick (1998). Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin 24, 3774.

PA Nutting , MA Goodwin , SA Flocke , SJ Zyzanski , KC Stange (2003). Continuity of primary care: to whom does it matter and when? Annals of Family Medicine 1, 149155.

M Phelan , M Slade , G Thornicroft , G Dunn , F Holloway , T Wykes , G Strathdee , L Loftus , P McCrone , P Hayward (1995). The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry 167, 589595.

S Sytema , P Burgess (1999). Continuity of care and readmission in two service systems: a comparative Victorian and Groningen case-register study. Acta Psychiatrica Scandinavica 100, 212219.

S Sytema , R Micciolo , M Tansella (1997). Continuity of care for patients with schizophrenia and related disorders: a comparative South-Verona and Groningen case-register study. Psychological Medicine 27, 13551362.

RC Tessler (1987). Continuity of care and client outcome. Psychosocial Rehabilitation Journal 11, 3953.

NC Ware , B Dickey , T Tugenberg , CA McHorney (2003). CONNECT: a measure of continuity of care in mental health services. Mental Health Services Research 5, 209221.

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Psychological Medicine
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