Throughout the world, there is a critical shortage of services for people with mental health and substance misuse concerns. These shortages are made worse by challenges coordinating services to treat both conditions.
Ireland’s Health Research Board recently released an evidence review on dual diagnosis treatment service for people with co-occurring mental health and substance use issues, conducted by the Georgia Health Policy Center. The rapid realist review sought to better understand what aspects of integrating services made it more likely that better treatment outcomes will be achieved.
“Understanding these facilitators and barriers is especially important in healthcare settings, including Ireland’s, where funding for services and other administrative challenges may be at odds with ensuring equitable access to services,” said Brian Galvin in a prepared summary of the review.
The review included a literature search, as well as engagement with knowledge users representing both providers and service users. Findings and recommendations from the review will inform efforts to build an integrated system, based on evidence-based models, that will ultimately improve outcomes for individuals in Ireland with co-occurring diagnoses.
“I would like to see more research, synthesis, and evaluation incorporate a realist approach to understand what works for whom in what circumstances,” says Karen Minyard, CEO of the Georgia Health Policy Center and lead of the realist review. “Using realist approaches helps us see the patterns in complex systems, as is the case with models of care for adults with co-occurring substance use and mental health service needs.”
The review of 151 articles aligned findings around the three outcome areas. Main findings include:
- Integration: Alignment of organizational and financial resources with strategy and policy is needed for integration of services, but does not guarantee success. A culture of hope and an empowering collaborative climate help to build providers’ confidence in their ability to implement changes in services and to address the needs of those with comorbid problems.
- Access: Staff knowledge and increased confidence related to training is associated with prompt diagnosis and consequently increased access to treatment. Staff adoption of a client-centered approach and displays of kindness are associated with increased patient engagement.
- Individual and family treatment outcomes: A dominant theme is the importance of engagement in treatment. Conditions that are associated with engagement are a supportive social network, progress in self-management behaviors, and stability in basic social and employment needs. A care system that works with the individual to establish a secure and stable environment makes engagement in treatment and recovery more likely.
Recommendations are categorized by the four levels where actions can be taken — policy or system, organization and provider, service and treatment, and individual and family. While development of integrated models of care will require alignment across levels, policies and resources that create incentives for integrated care; develop a knowledgeable, coordinated workforce; and foster a person-centered approach are key, high-leverage strategies.
For more information on the review or its recommendations, access the report here.