Integrating services for patients with mental and substance use disorders: What matters?

Abstract

Background: Over the past decade, practice standards have recommended that people suffering from 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 addiction rehabilitation services.

Purpose: The purpose of this study was to identify key factors in integrating services for patients with co-occurring disorders.

Methodology: We conducted a process evaluation with the aim of identifying factors that enhance or impede service integration. First, we elaborated a sound conceptual framework of service integration. We then conducted in-depth case studies analysis using socioanthropological methods (interviews with managers and professionals, focus groups with patients, nonparticipant observation, and document analysis). We analyzed two contrasted forms of services integration, a joint venture and a strategic alliance, separately and then compared them.

Findings: The integrations achieved in the two cases were of different intensities. However, from our study, we were able to identify various levers and characteristics that affect the development of an integrated approach. Reflecting on the dynamics of these two cases, we formulated six propositions to identify what matters when integrating services for persons with mental and substance use disorders.

Practice implications: The integration of services transcends debates on care models and must be focused on the patients' experience of care. The process should stimulate a learning experience that helps to align practices (normative integration) and to integrate teams and care. In this study, we identified a number of key conditions and levers for success.

Figure 1

Conceptual model for service integration

Figure 2

Toward integration. What matters