Integrated models for concurrent disorders from a Public Mental Health lens: a Systematic Review

Abstract

Abstract Concurrent disorders (COD), historically defined by the World Health Organization as the simultaneous presence of a psychoactive substance use disorder and another psychiatric disorder within the same individual, pose a significant challenge to public mental health. In today’s global landscape of mental health services, the prevalence of COD is on the rise, underscoring the need for an integrated approach to management. This review aims to provide an overview of existing global models and the evaluation approaches. This systematic review examined research evidence in PubMed, Scopus and Web of Science up to 2023 regarding integrated management systems for COD. Following PRISMA guidelines, we included articles describing specific models and evaluating the effectiveness of integrated versus non-integrated approaches. Quality assessment was conducted using the appropriate scales. Out of 7700 screened articles, 18 were included, all of fair or good quality. A diverse array of patient care models, programs, and interventions addressing comorbidities between mental health and substance use disorders emerged. The majority of studies focused on clinical outcomes, particularly alcohol and drug dependence, with global mental health consequences also under examination. Psychodiagnostics and social outcomes were also considered in a significant portion of the research, shedding light on health services utilization patterns. The integrated model for concurrent disorders in psychiatry stands as an effective approach, yet its implementation encounters challenges. This study showcases successful integration examples, providing valuable insights for policymakers and healthcare professionals to enhance existing models or develop new ones, particularly within European healthcare reforms like Italy’s restructuring of primary care, where they could serve as a criterion for the setting and organization of community houses. Key messages • COD, involving both substance use and psychiatric disorders, present a significant challenge to public mental health. Rising prevalence underscores the need for integrated management approaches. • Insights from successful integration examples offer valuable guidance for healthcare professionals and policymakers, particularly within healthcare reforms like Italy’s restructuring of primary care.