Integrated care for individuals with mental illness and substance abuse – the example of the coordinated individual plan in Sweden

ABSTRACT

Specialisation in care and welfare services often leads to inflexible boundaries between organisations and professions, resulting in fragmented and ineffective care, not least in the areas of severe mental illness and substance abuse. Collaborative models such as case management, multidisciplinary teams and coordinated care plans are used in many countries to address this problem. In a parallel development, demands have been made that individual users/patients should have more influence over their own care. In Sweden, legislation requires the social service and health care to draw up Coordinated Individual Plans (CIP) to clarify responsibility, improve the care process and increase users’ involvement in their own care. This article explores the impact of coordinated care plans, using the Swedish CIP as an example. What can we learn about conditions for integrated care according to the degree of collaboration, involvement for the individual user and supporting structures? The authors have studied 25 case files in a local authority. Findings indicate a low to moderate degree of collaboration and few indications of meaningful user involvement. Further studies are needed concerning factors hindering CIP from achieving a higher degree of collaboration and fully including the intentions and wishes of the individual.

ABSTRAKT

Specialisering och sektorisering i välfärdsservice orsakar svårigheter i många länder, inte minst för vuxna med komplexa behov i samband med missbruk och psykisk ohälsa. Modeller för samverkan, t.ex. case management, multidisciplinära team och individuella samordnade planer, används i många länder i syfte att uppnå en högre grad av integration mellan organisationer. Samtidigt har kraven ökat för att brukare/patienter ska ha större påverkan över sin egen vård. I Sverige kräver lagstiftning att socialtjänst- och hälso- och sjukvårdvårdssektorerna gör Samordnade Individuella Planer (SIP, eng. CIP) kring enskilda brukare i syfte att klargöra frågor om ansvar och förbättra vårdprocesser samt för att öka brukarnas delaktighet i sin egen vård. Denna explorativa studie undersöker vilken påverkan samordnade planer har haft, med den svenska SIPen som exempel. Vad kan vi lära oss om villkoren för integrerad vård utifrån graden av samverkan, delaktighet för brukaren samt stödjande strukturers roll i genomförandet av SIP? Författarna har studerat 25 akter i en kommun. Resultaten visar en låg till måttlig grad av samverkan med få indikationer på meningsfull brukardelaktighet. Ytterligare forskning behövs för att undersöka vilka faktorer som hindrar CIP från att uppnå en högre grad av samverkan och helt omfatta den enskilde brukarens intentioner och önskemål.

KEYWORDS:

• Coordinated individual plan
• collaboration
• user involvement
• complex needs
• integrated care

NYCKELORD:

• Samordnad Individuell Plan (SIP)
• samverkan
• brukardelaktighet
• komplexa behov
• integrerad vård

Acknowledgements

The empirical data in this study is a portion of the data collected in a study done in cooperation between the Department of Social Work at Stockholm University and RD Northeast (FoU Nordost), which is a research and development unit for the social service in seven local authorities in the Stockholm area. The study was completed within the respective organisation’s resources, without external funding.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

David Matscheck

David Matscheck, master of social work, has extensive experience from the social service and as a researcher and project leader for RD Northeast (FoU Nordost). His main areas of research are collaboration/integrated care and social perspectives on mental health. Other previous publications have concerned user involvement for individuals with mental health impairments and assessments of need for children and young people. He is currently a lecturer at the Department of Social Work, Stockholm University.

Katarina Piuva

Katarina Piuva, PhD, is associate professor at the Department of Social Work, Stockholm University. Her research concerns social work in the field of mental health, which includes social conditions for persons with mental health problems, the position of family members, and the social political perspective on the development of the profession.