Improving engagement and health and care outcomes for people with co-existing mental health and substance misuse conditions

BACKGROUND Around 30-50% of people with serious mental illness also have co-existing alcohol/drug conditions (COSMHAD) and this co-morbidity is associated with poor health outcomes. One of the issues is that there is disjointed care by mental health and alcohol/drug services, and limited evidence on which to base effective services. AIM: In response to the commissioning brief, the aim is generate a programme theory (using realist synthesis of evidence and stakeholder views) that identifies and describes the contexts and associated mechanisms by which engagement and other health outcomes are achieved in service systems for COSMHAD, and for whom these are most effective. RESEARCH QUESTIONS: 1. What does the existing literature suggest 'works' (demonstrated by engagement and other health outcomes) in terms of COSMHAD, for whom, and in which circumstances? 2. What are the current range and types of service systems that currently operate in the UK that aim to improve engagement and health outcomes for people with COSMHAD? 3. What are the specific contexts and mechanisms that make COSMHAD models successful (or not), for whom and under what contexts? METHOD: The overarching method will be Realist Methodology. SETTING any service (primary or secondly services) that has specifically funded posts for COSMHAD; or provides some form of formalised care pathway or integrated package of care, or interventions specifically aimed at people with COSMHAD. This includes NHS mental health and substance use services , third sector providers, charities and voluntary services, criminal justice, and housing and social care (not exhaustive). POPULATION: people who commission or provide COSMHAD services; those who access the services and their carers HEALTH TECHNOLOGIES BEING ASSESSED: any service model or pathway; any psychosocial intervention or psychological therapy that is aimed at specifically improving engagement and health outcomes for people with serious mental illness and co-existing alcohol/drug conditions. WORKPACKAGES: WP1: realist evidence synthesis of literature WP2:Mapping and auditing of services in the UK. The first phase will be a mapping of COSHMAD services based on web searching, identification via relevant networks and snowballing of local contacts. this first wave will be to simply create a map of known services and a key contact in every place. A survey will be devised to gather more information about the services - will include who commissions; remit, number and types of staff and volunteers, type of service, types of intervention offered, any evaluations been undertaken. A survey will be co-produced with the team and advisors. WP3:Stakeholder focus groups in 5 locations in the UK. The questions will be informed by the realist approach and the findings of WP1 and 2. In addition 10 individual interviews will be undertaken with a purposive sample of people who are harder to reach (such as people who are homeless, women, offenders) in two locations. The data will be synthesised across the three work packages, and a final event will be held with stakeholders to finalise the research priorities (using nominal group technique). OUTPUTS AND DISSEMINATION: We will share findings as they emerge using a website and social media to launch blogs and academic papers. In addition there will be a final report to HTA, conferences, and executive and lay summaries via established networks.