Care models for co-existing serious mental health and alcohol/drug conditions: the RECO realist evidence synthesis and case study evaluation

Elizabeth Hughes, Jane Harris, Tom Ainscough, Angela Bate, Alex Copello, Sonia Dalkin, Gail Gilchrist, Emma Griffith, Lisa Jones, Michelle Maden, Luke Mitcheson, Harry Sumnall, Charlotte Walker

Research output: Contribution to journalArticlepeer-review

Abstract

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 coordinated approach which means that some people can fall between services. Despite these concerns, there is limited evidence as to what works for 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 6 locations in the UK (5 in England and 1 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 PTs. 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 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 IT equipment.

Conclusion: The RECO study provides details on how and in what circumstances integrated care can work better for people with COSMHAD. 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 COSMHAD 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.
Original languageEnglish
Number of pages128
JournalHealth Technology Assessment
Volume28
Issue number67
Early online date11 Oct 2024
DOIs
Publication statusPublished - 11 Oct 2024

Funding

This study was funded by the NIHR Health Technology Assessment NIHR 128128

FundersFunder number
NIHR Health Technology Assessment128128

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