Care models for coexisting serious mental health and alcohol/drug conditions: the RECO realist evidence synthesis and case study evaluation
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Le résumé fourni par la source
Background: People with severe mental illness who experience co-occurring substance use experience poor outcome including suicide, violence, relapses and use of crisis services. They struggle to access care and treatment due to a lack of an integrated and co-ordinated approach which means that some people can fall between services. Despite these concerns, there is limited evidence as to what works for this population. Objectives: To undertake a realist evaluation of service models in order to identify and refine programme theories of what works under what contexts for this population. Design: Realist synthesis and evaluation using published literature and case study data. Setting: Mental health, substance use and related services that had some form of service provision in six locations in the United Kingdom (five in England and one in Northern Ireland). Participants: People with lived experience of severe mental illness and co-occurring substance use, carers and staff who work in the specialist roles as well as staff in mental health and substance use services. Results: Eleven initial programme theories were generated by the evidence synthesis and in conjunction with stakeholders. These theories were refined through focus groups and interviews with 58 staff, 25 service users and 12 carers across the 6 case study areas. We identified three forms of service provision (network, consultancy and lead and link worker); however, all offered broadly similar interventions. Evidence was identified to support most of the 11 programme theories. Theories clustered around effective leadership, workforce development and collaborative integrated care pathways. Outcomes that are meaningful for service users and staff were identified, including the importance of engagement. Limitations: The requirement for online data collection (due to the COVID-19 pandemic) worked well for staff data but worked less well for service users and carers. Consequently, this may have reduced the involvement of those without access to information technology equipment. Conclusion: The realist evaluation co-occurring study provides details on how and in what circumstances integrated care can work better for people with co-occurring severe mental health and alcohol/drug conditions. This requires joined-up policy at government level and local integration of services. We have also identified the value of expert clinicians who can support the workforce in sustaining this programme of work. People with co-occurring severe mental health and alcohol/drug conditions have complex and multifaceted needs which require a comprehensive and long-term integrated approach. The shift to integrated health and social care is promising but will require local support (local expert leaders, network opportunities and clarity of roles). Future work: Further work should evaluate the effectiveness and cost-effectiveness of service models for this group. Study registration: This study is registered as PROSPERO CRD42020168667. Funding: ; Vol. 28, No. 67. See the NIHR Funding and Awards website for further award information.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Care models for coexisting serious mental health and alcohol/drug conditions: the RECO realist evidence synthesis and case study evaluation
- Date Crossref
- 01/10/2024
- Éditeur
- National Institute for Health and Care Research
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Glasgow Caledonian University pays non établi dans la noticeUniversité ou école supérieure
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Liverpool John Moores University Public and Allied Health pays non établi dans la noticeUniversité ou école supérieure
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University of Leeds pays non établi dans la noticeUniversité ou école supérieure
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Northumbria University Coach Lane Campus West pays non établi dans la noticeUniversité ou école supérieure
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University of Birmingham pays non établi dans la noticeUniversité ou école supérieure
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Avon and Wiltshire Mental Health Partnership NHS Trust pays non établi dans la noticeÉtablissement de santé
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Blackberry Hill Hospital Avon and Wiltshire Mental Health Partnership NHS Trust pays non établi dans la noticeÉtablissement de santé
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University of Liverpool Institute of Population Health pays non établi dans la noticeUniversité ou école supérieure
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Lambeth Hospital pays non établi dans la noticeÉtablissement de santé
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School of Health and Life Sciences pays non établi dans la noticeUniversité ou école supérieure
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School of Healthcare pays non établi dans la noticeUniversité ou école supérieure
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School of Psychology pays non établi dans la noticeUniversité ou école supérieure
Glasgow Caledonian University, Public and Allied Health — Liverpool John Moores University et University of Leeds, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.