CollabOrative Care Model for Bipolar DisOrder (COMBO)

OxfordMental Health
Start Date: 3 Oct 2016

CollabOrative Care Model for Bipolar DisOrder (COMBO) 


People with bipolar disorder and the doctors and nurses looking after them in their GP surgeries (primary care).


True Colours (TC), a web-based symptom monitoring service for people with bipolar disorder, allowing people to record their symptoms over time.
The TC service prompts participants to answer questionnaires (usually once a week) by their preferred method (SMS/texting or e-mail). Their answers are plotted a graph, which they can view and add notes to, such as treatment changes.
This record can help people to manage their own health as well as share information with their care teams, allowing ‘early warning signs’ of relapse to be recognised and acted upon quickly.


•    To assess using True Colours for patients with mood instability and bipolar disorder in primary care.
•    To assess whether the addition of smartwatches to obtain additional information can enhance True Colours.
•    These studies will help us design a new way of caring for patients with bipolar disorder that involves both their GPs and specialist mental health services.

Why this is important

Bipolar disorder is a mental health problem affecting around 2 million people in the UK.  People with bipolar disorder experience ‘mood instability’ – episodes of feeling manic or 'high' and depressed or 'low', over time.
While we all experience changes in mood, in bipolar disorder these changes are much more extreme, which leads to distress, badly affecting or disrupting day-to-day lives.
Patients have highlighted difficulties in getting specialist assessment and treatment, delaying diagnosis and getting the best possible care.
Often, depending on the severity and nature of their current mood state, patients can be moved back-and-forth between primary (GP) and secondary care (specialist mental health services). Not only can patients find this disjointed, inconsistent and frustrating, but it can also prevent them from getting the best possible care.
There is a clear need to develop new ways of delivering care services for people with bipolar disorder. True Colours could be used as a means to achieve this. TC could be used to share information, helping patients, primary and secondary care work closer together to deliver an improved, more efficient service to patients: a ‘collaborative care model’.


This research will use the ‘True Colours’ (TC) mood self-monitoring tool for patients with bipolar disorder, to link patients and carers with both primary and secondary care teams.
This research is a ‘feasibility study’, a study aiming to see if a larger study would be possible or practical and to gauge effectiveness, so will only involve a small number of participants to start with, around 50 patients and 2-3 GP surgeries. Though more may be added.
The clinicians and patients that take part will be trained in using True Colours.
All three groups – patients, GPS and secondary care clinicians – will be interviewed to investigate how the TC system is being used, and to gather and understand their experience of using TC.
These interviews will be used to:
1)    find out what the people using TC like and dislike about it;
2)    test whether TC works well to support collaborative care between GPs, patients and specialists; and
3)    find new improvements or features to make TC work better.
Alongside this, a smartwatch (a wearable computer closely resembling a wristwatch that can connect to mobile phones wirelessly) companion application (or ‘app’) of True Colours will be developed.
This app will be used for mood monitoring and other measures, such as activity levels. This will be assessed to see if it can improve the information gathered from True Colours. For example, by revealing how daily patterns of physical, social or other activities are related to mood. This may provide new ways of detecting relapses or assisting in diagnosis.

How this could benefit patients

This research could help patients with bipolar disorder get the help they need faster, improving their quality of life by providing a way for different health services to work together more effectively in caring for patients.
Such ‘collaborative’ ways of caring may also free up time and resources in the NHS, meaning more people may be treated faster.
Additionally, the findings from this work could also help to inform the development of new services for a range of other conditions where collaborative care models may prove beneficial for patients, from cancer to diabetes.