Skip to main content
    • Aa
    • Aa

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)...

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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

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.

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.

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.

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.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 7
Total number of PDF views: 62 *
Loading metrics...

Abstract views

Total abstract views: 319 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st September 2017. This data will be updated every 24 hours.