An expert consensus to identify optimal models of integrated care for people with severe mental illness and comorbidities in Europe.

Abstract

Background: Individuals with serious mental illness (SMI), including psychotic, bipolar, and major depressive disorders, face complex health needs, including poor somatic health, a high prevalence of chronic physical conditions and reduced life expectancy. Although a variety of integrated care models have been developed to tackle these needs, the available evidence remains scarce, and no definitive best-practice model has been established. Moreover, the involvement of individuals with SMI in the design of such models is still rare. As part of the European mental and physical health initiative for people with severe mental disorders (EU-MIND), this study aims to reach an expert consensus on the most promising and acceptable integrated care models for individuals with SMI across six European countries.   Approach: We adopt the Delphi consensus method, widely recognized in health sciences research as a robust and systematic approach to gathering expert judgment and discerning areas of agreement and disagreement where high-quality evidence is limited. This study engages key stakeholders as participants, including people with lived experience of SMI, their relatives, health and social care providers, and policymakers from six European countries: Denmark, Finland, France, Italy, Poland, and Sweden. These countries were selected to reflect a diversity of geographical regions – Northern, Southern, Western, and Eastern Europe – as well as a range of health system models. The Delphi study will consist of three iterative rounds of online questionnaires over a two-month period starting in early 2026. The questionnaire is structured around a taxonomy derived from a scoping literature review and informed by the conceptual SELFIE framework for integrated care for multimorbidity. It explores the potential attributes of integrated care models for people with SMI – spanning governance, service delivery, workforce, funding, information and technology, and research and evaluation. Participants will independently prioritize these attributes, receive structured feedback between rounds, and re-evaluate the items until a consensus is achieved.       Results: Although empirical findings are not yet available at the time of writing, this consensus-building process itself constitutes a significant advance in the field. By systematically capturing the perspectives of diverse stakeholders and synthesizing expert opinion across varied health system contexts, the study is expected to deliver a refined set of key attributes for integrated care models for people with SMI. These results, available at the time of the conference, will provide an evidence-informed foundation for the design, implementation, and future evaluation of integrated care interventions in real-world settings for this population with unique needs.   Implications: By prioritizing stakeholder perspectives and harnessing expert consensus, this research will bridge current knowledge gaps and guide the development of equitable, person-centered organizational interventions aimed at reducing physical health disparities among people with SMI in Europe. The consensus generated through this project will serve as a critical steppingstone for policy and practice innovation in integrated care.