Integrated care for people who use alcohol and/or other drugs: A case study analysis of the current landscape in England

By William D. Phillips, Jessica Dawney, Emily Hutton, Avery Adams, Lucy Strang, Katherine I. Morley, Nicola Kalk, Jennifer Bostock, Andrew Jones, Tom Ling, Tim Millar, Joanne Neale, John Strang, Jon Sussex, Jennifer Newbould

This study examined how treatment and recovery services are integrated with physical and mental health services following additional funding from England's drug strategy. Findings show wide variation in the extent and type of integration across local areas. While some progress has been made, more needs to be done to strengthen collaboration and achieve effective, person-centred care.

Key Findings

There is substantial variation in what services are offering across different local areas

• While certain activities - such as embedding treatment and recovery staff in broader health services to encourage inward referrals - are relatively consistent across local areas, other initiatives are more localised. This is driven by variations in the stage of development of different services, differences in resourcing and local context, and the varying strength of existing relationships and connections.

We identify five models of integration for treatment and recovery services and an optimal example of an integrated care pathway.

• We conceptualise the following models to help policymakers think about how to monitor, evaluate and communicate about service integration going forward:

• Model 1 - single point of access

• Model 2 - embedded workers

• Model 3 - joint planned care

• Model 4 - leveraging external support

• Model 5 - building in-house expertise

• .

• Many treatment and recovery services are struggling to meet even basic needs due to high caseloads. Limited, short-term and inconsistent funding compounds these problems, making long-term planning and integration very difficult. Stigma, especially within mental health services, also remains a major barrier.

Recommendations

Central government should:

• Facilitate the dissemination and implementation of the co-occurring mental health and substance use delivery framework

• Identify priority interventions for service integration

• Explore ring fenced, longer-term funding for integrating services

• Examine ways in which integration efforts could be measured and monitored.

ICPs should:

• Consider establishing a dedicated role for treatment and recovery services.

Treatment and recovery services should:

• Provide basic mental health training to screen for and deliver mental health interventions

• Strengthen relationships with other health services.

ICPs and treatment and recovery services should:

• Ensure training on substance use is implemented across all healthcare settings, prioritising mental health services.