Co-occurring mental health and addiction disorders: The elusive path to integrated care

Abstract

Background: Co-occurrence of mental health and addictions disorders occurs at a high rate, posing significant costs to affected individuals and society if left untreated. Although decades of research and policy reports have argued the necessity of integrated mental health and addiction services to effectively treat this population, it appears as though relatively little integration has been achieved. Methods: This exploratory study used key informant interviews to investigate the current state of integrated treatment in Ontario, Canada, potential models for integrated treatment and barriers to their implementation. Interview transcripts were analyzed inductively, and thematic analysis used to identify emerging themes. Results: Five domains were identified: organizational barriers, system barriers, historical barriers, barriers related to stigma and discrimination, and knowledge barriers. A key challenge is the absence of provincial direction and limited evidence on the relative effectiveness of the different integrated treatment models. Discussion and Conclusion: Insights from interviews with research, policy and provider experts clarify the relevant factors affecting the implementation of integrated treatment in Ontario. In identifying potential models of integration and the barriers to their implementation, further research is required to assess the relative effectiveness of the different integration models and to identify the critical organizational and system factors needed for successful implementation of integrated care. Avenues that merit further exploration are the fields of implementation science and complex adaptive systems.