Key enhancing factors for integrating services for patients with mental and substance use disorders

Abstract

Background: Over the past decade, practice standards have recommended that people experiencing both mental and substance use disorders receive integrated treatment. Yet few institutions offer integrated services, and patients are too often turned away from psychiatric and rehabilitation services.

Aim: To identify key enhancing elements for integrating services for patients with co-occurring disorders.

Methods: A process evaluation was conducted, using case study research methodology, with the aim of identifying factors that enhance or impede service integration. First, we elaborated a sound conceptual framework of service integration. In-depth case studies analysis using socio-anthropological methods (interviews with managers and professionals, focus groups with patients, non-participant observation, document analysis) were then conducted. Two contrasted forms of services integration, a joint venture and a strategic alliance, were analysed separately, and then compared.

Results: Although the forms of integration studied were much contrasted, the same enhancing mechanisms – clinical leadership, training, communication and institutional support – were identified, thus confirming the relevance of these factors in integration processes.

Conclusion: Whereas the organizational structure appears to be facilitating but insufficient for integrating care, strong clinical leadership with some basic institutional support can, through training and communication activities, have a significant impact on patients' integrated care.

Keywords:

• co-occurring disorders
• evaluation
• integrated approach
• mental health
• services integration
• substance use

Acknowledgements

The authors gratefully acknowledge the financial support of the Canadian Institutes for Health Research for the realization of this research and the Fonds de Recherche en Santé du Québec (FRSQ) that supports Astrid Brousselle's young investigator award and Chantal Sylvain's doctoral fellowship.