The views and experiences of service providers working to integrate mental health and addiction services for individuals with co-occurring serious mental health and substance use disorder in the United Kingdom: A qualitative systematic review

Public Health Addictions Dissertation Prize Winner

Abstract

Background: Although the prevalence of co-occurring disorders, which includes both substance-use disorder and serious mental health, is widespread, the disposition and combinations of these disorders can vary greatly. In addition to a long recovery process, people who experience co-occurring disorders have a higher risk of developing other health concerns and may experience early deaths. Integrating mental health care with treatment for alcohol and other drugs has long been recommended to improve outcomes for people with co-occurring disorders, but despite this mental health and addiction services continue to operate in separate silos in many high-income countries. This review examined the views and experiences of service providers in high income countries on integrating co-occurring services and the factors that influence health outcomes. 

Methods: The research involved a qualitative systematic review. A literature search was conducted using Medline, CINAHL, and grey literature from 2010 to April 2024. The population, interest and context framework were used to develop the search strategy. The inclusion criterion were primary qualitative studies within high income countries. The critical appraisal skills programme (CASP) qualitative checklist was utilised to evaluate the quality of the papers. Thematic synthesis was adopted to analyse the studies (Thomas and Harden, 2008). 

Results: The review included 6 studies on diverse professionals’ views on integrating mental health and addiction services. There were 3 analytical themes 1) appropriate training 2) management of care 3) barriers to the integration of mental health and addiction services. Several of the concerns and knowledge gaps regarding the integration of services were shared between service providers. 

Conclusion: There are varying levels of knowledge and views regarding the integration of mental health and addiction services. However, service providers faced issues with a lack of training, experience and knowledge.  More experience could reduce stigma and address uncertainties for better treatment outcomes and services for people with co-occurring conditions. This review was the first to provide a synthesis of the views and experiences of service providers in high income countries. Recommendations are made for policy, practitioners and service users. Furthermore, important implications for public health can be drawn from this review.