TY - JOUR
T1 - Achieving Integrated Treatment
T2 - A realist synthesis of service models and systems for co-existing serious mental health and substance use conditions
AU - Harris, Janet
AU - Dalkin, Sonia
AU - Jones, Lisa
AU - Ainscough, Tom
AU - Maden, Michelle
AU - Bate, Angela
AU - Copello, Alexandre
AU - Gilchrist, Gail
AU - Griffith, Emma
AU - Mitcheson, Luke
AU - Sumnall, Harry
AU - Hughes, Elizabeth
N1 - Funding information: Study funded by NIHR Health Technology Assessment 128128. The views expressed are those of the author(s) and not necessarily those of NIHR or Department of Health and Social Care
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Approximately 30–50% of people with serious mental illness have co-existing drug or alcohol problems (COSMHAD), associated with adverse health and social care outcomes. UK guidelines advocate both co-occurring needs being met within mental health services, but uncertainty remains about how to operationalise this to improve outcomes. Various unevaluated service configurations exist in the UK. A realist synthesis was done to identify, test, and refine programme theories of how context shapes the mechanisms through which UK service models for COSMHAD work, for whom, and in what circumstances. Structured and iterative realist searches of seven databases identified 5099 records. A two-stage screening process identified 132 papers. Three broad contextual factors shaped COSMHAD services across 11 programme theories: committed leadership, clear expectations regarding COSMHAD from mental health and substance use workforces, and clear care-coordination processes. These contextual factors led to increased staff empathy, confidence, legitimisation, and multidisciplinary ethos, which improved care coordination and increased the motivation of people with COSMHAD to work towards their goals. Our synthesis highlights that integrating COSMHAD care is complex, and both individual and cultural behavioural shifts in leadership, workforce, and service delivery are essential to ensure people with COSMHAD receive compassionate, trauma-informed care that meets their needs.
AB - Approximately 30–50% of people with serious mental illness have co-existing drug or alcohol problems (COSMHAD), associated with adverse health and social care outcomes. UK guidelines advocate both co-occurring needs being met within mental health services, but uncertainty remains about how to operationalise this to improve outcomes. Various unevaluated service configurations exist in the UK. A realist synthesis was done to identify, test, and refine programme theories of how context shapes the mechanisms through which UK service models for COSMHAD work, for whom, and in what circumstances. Structured and iterative realist searches of seven databases identified 5099 records. A two-stage screening process identified 132 papers. Three broad contextual factors shaped COSMHAD services across 11 programme theories: committed leadership, clear expectations regarding COSMHAD from mental health and substance use workforces, and clear care-coordination processes. These contextual factors led to increased staff empathy, confidence, legitimisation, and multidisciplinary ethos, which improved care coordination and increased the motivation of people with COSMHAD to work towards their goals. Our synthesis highlights that integrating COSMHAD care is complex, and both individual and cultural behavioural shifts in leadership, workforce, and service delivery are essential to ensure people with COSMHAD receive compassionate, trauma-informed care that meets their needs.
UR - http://www.scopus.com/inward/record.url?scp=85165567906&partnerID=8YFLogxK
U2 - 10.1016/S2215-0366(23)00104-9
DO - 10.1016/S2215-0366(23)00104-9
M3 - Review article
SN - 2215-0366
VL - 10
SP - 632
EP - 643
JO - The Lancet Psychiatry
JF - The Lancet Psychiatry
IS - 8
ER -