Addressing a person’s alcohol and other drug and mental health problems doesn’t need integration of different mental health services. The evidence for integrated care is limited, but there is evidence that meeting the diverse needs of clients improves both retention and outcomes.
Within-service holistic wrap-around client care
Providing wrap around services that address a person’s medical, educational, and mental health needs in alcohol and other drug treatment improves retention and treatment outcomes.
Holistic, wraparound client care should be routine in both mental health and alcohol and other drug settings. Providing this kind of holistic care wherever the client has made first contact seems to be more effective than service integration.
Health professionals in each sector need to understand the types of co-occurring problems they may each face and what is within their capacity to respond to.
Improving collaboration between AOD and mental health services
Currently, the alcohol and other drug and mental health sectors work primarily on a loose coordination approach in which individual practitioners from different sectors work together to get the best outcomes for clients. The downside to this approach is that it relies on the good will of individual practitioners to engage in shared care arrangements, and service users can fall through the gaps.
Improving relationships between agencies and encouraging collaboration in the form of structured case conferencing, agreements on collaboration of services or co-location of professionals could improve responses, without the need for major structural or cultural change.
Co-locating mental health services
Colocation, in which multiple services are geographically located together, has been shown to facilitate working relationships and referral pathways, and therefore client outcomes.
Co-locating behavioural health providers in community health centres, for example, seems to increase screening for alcohol and other drug problems by primary care providers, improves referral to specialist alcohol and other drug treatment.
Where to from here
There appears to be no benefit in integrating AOD and mental health services. It is complex and expensive to achieve, and unlikely to achieve the expected client outcomes.
Alternative options, which are probably less costly and do not require major disruption to sector or organisational culture are likely to achieve better outcomes.
Step 1: Within each service, improve holistic assessment and wraparound care
Step 2: Improve formal collaboration structures and processes between AOD and mental health services.
Step 3: Co-locate rather than integrate
Given the lack of evidence for integration, we should put more effort and funding into linking up services more effectively and more formally.