Effectiveness and implementation of an inpatient mental health care pathway at an epilepsy center: a prospective service evaluation

Objectives This hybrid study assessed the implementation and clinical effectiveness of a structured mental health care workflow for epilepsy.

Methods Eligible inpatients were screened systematically. Patients with scores above cutoff scores underwent structured diagnostic interviews followed by a multi-component psychotherapeutic intervention (one or two sessions) aiming to develop a personalized treatment plan. Follow-up at 1, 3, 6, and 12 months assessed treatment plan adherence and reliable change indices (RCIs) of outcomes (self-reported depressive and anxiety symptoms, health-related quality of life, work and social adjustment). Implementation was assessed through initial step penetration, fidelity of workflow execution, and diagnostic/therapeutic yields (appropriateness).

Results Of 345 inpatients with epilepsy, 210 were eligible and 202 entered screening. Neurocognitive and linguistic deficits were the most important reasons that only 59% of all inpatients completed the screening procedure. The workflow was implemented with high fidelity (96% across all steps) and proved clinically appropriate for the population, with one in five screened patients with epilepsy receiving a psychiatric diagnosis and a personalized treatment plan based on the brief, tailored psychotherapeutic intervention (n = 41). Fifteen of these patients (37%) had not been diagnosed previously. After 12 months, 17 patients (41%) were lost to follow-up; this group showed significantly higher baseline depression scores. Of the 24 patients with complete follow-up data, 17 (71%) had initiated the recommended treatment. Eleven of those who had started treatment (65%) showed reliable improvements in at least one outcome, whereas no improvements were observed in non-adherent patients.

Significance The integrated workflow was implemented with high fidelity and was associated with promising outcomes. However, the findings highlight the need for structural reforms to improve access and effectiveness for patients with cognitive impairment, language barriers, and severe depressive symptoms.