Patient Care for people with Substance Abuse and Mental Illness

This is a current state of knowledge on patient pathways for adults with concurrent substance use and mental health disorders. The summary identifies and presents relevant professional, legal and political documents which regulate and define the course of patient pathways for this patient group, and it includes research and development publications published between 2008 and 2017, written in a Scandinavian language or English, with empirical results from Norway. However, international reviews and Nordic studies have been included where their conclusions are of special value or relevance for the Norwegian context.

The research and development studies included in the summary show that many adults with concurrent substance use and mental health disorders face major challenges with respect to living and health conditions. The patient group is especially vulnerable when confronted with lack of continuity and coordination in service provision. Both the literature and national guidelines indicate the importance of integrated, flexible services where patients are treated for both disorders concurrently and by the same health personnel. However, according to the literature, it is at this point that there is a significant risk of failure. Further, it is emphasised that providing this patient group with treatment is generally challenging. Many patients find it difficult to make use of the existing treatment and follow-up services in the municipality, and successful treatment is often contingent on cooperation and coordination with other agencies outside of the treatment organisation itself.

The summary outlines both the potential benefits and challenges associated with different approaches and perspectives found in the municipalities and the specialist health service. It describes statutory plans and agreements, the use of information and communications technology, and the GP’s role in the care of people with concurrent substance use and mental health disorders. It highlights the importance of personal relationships for the patient pathway, the challenges related to procuring adapted and stable housing provision and how the lack of housing or inadequate housing provision can undo a positive treatment and recovery process.

Over the last few years, Norwegian authorities have subsidised the development and establishment of organisational collaboration models that are binding on the municipalities and the specialist health service. Funding has been given to various support and follow-up measures to support housing provision and work. And learning networks have been established to develop good patient pathways within the municipalities. The summary includes experiences, reflections and research from a learning network and twelve models and measures. It makes it clear that there are a series of positive experiences with successful collaboration and well-working measures in the municipalities. At the same time, geography, the number of residents and the structure of local services all help shape which models and measures might be appropriate for each municipality.