Coordination of services for dual diagnosis clients in the interface between specialist and community care

Abstract

PurposeThe aim of this article is to study the coordination of comprehensive services for clients with concurrent substance abuse and mental health disorders (dual diagnosis), which is a very complex client group. In order to achieve comprehensive care and treatment, the service providers need to cooperate and coordinate, but the questions here, are how this is done and how appropriate the coordination is.Data and methodsData were collected from group interviews during a 1-day workshop with clients, relatives, and employees from the various services involved.ResultsInformation exchange between the services was generally in writing. Coordination between substance abuse and mental health services was experienced as fragmented. Employees had an unclear perception of the work and expertise of the other service providers involved. There were examples of disparity between the services a municipality could offer and client needs. A coordinator, if available, was emphasized by both clients and service providers as serving an important function in coordination and relationship building.ConclusionPredominantly written communication and unclear division of responsibilities and duties resulted in employees creating stereotypes of each other, both within specialist health services and between specialist and municipal health services. A coordinator was able to coordinate various inputs, often through informal contact, with a view to establishing appropriate services for individual clients. Coordination in interagency meeting points, such as “responsibility teams”, was the most successful solution, but this will involve a greater degree of networking than is common today.

Collaborative challenges in the use of telecare

“…In other words, it was apparently accepted at different levels of the organisation not to use meeting points as a model for cooperation. The lack of meeting points to encourage collaboration has also been observed in other studies within health and social care . Reeves et al argue that the complexity of organising and coordinating services requires that professionals meet and reach agreement on work to be done in addition to sharing information.…”

Hvordan praktisere brukermedvirkning uten brukeren?

“…Systemforankring av personlige relasjoner En balanse mellom formelle og uformelle mekanismer for samhandling på lokalt plan framsto som viktig for å bygge en kontekst for effektiv medvirkning. Det var her relasjoner ble etablert som kunne bygge opp under varige nettverk der medvirkning var mulig for alle (Bjørkquist & Hansen, 2018). Det var også på dette nivået relasjoner og nettverk var forankret organisatorisk.…”

Structural disavowal and personal inundation of responsibility – a local perspective on pressure on mental health front-line professionalsStrukturell ansvarsfraskrivelse og individuell ansvarsoversvømmelse – kommunalt perspektiv på dilemmaer i profesjonelt arbeidet med rus og psykisk helse

“…During the last 20 years, there has been a substantial growth in services to people with mental health and addiction problems in Norway. The Escalation Plan on Mental Health (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) (Norwegian Ministry of Health and Social Affairs, 1998) and the Addiction Service Escalation Plan (Norwegian Ministry of Health and Care Services, 2015) have been major national strategies to strengthen the number and competence of mental health personnel, client perspectives on services and the focus on integrated services (Bjørkquist & Hansen, 2018). However, evaluations of the national reforms conclude that while quantitative measures are generally met, quality measures still fall behind, particularly regarding strategies to provide more holistic, coordinated services.…”

“…According to Vike (2017), dilemmas of the welfare state include the gap between resources and often unsolved tasks. Health and social services are under constant pressure, due to several intertwined reasons: The political ambitions are greater than the actual resources (funding and personnel), and patients now have more extensive legal rights as to how much, how and when services should be provided (Bjørkquist & Hansen, 2018). Furthermore, the dynamics of professional knowledge has created expectations of medical outcomes never seen before (World Health Organization, 2005).…”

“…In contrast to linear treatment processes, patients with concurrent diagnoses tend to experience broken, non-linear services from a number of (mostly uncoordinated) service units (Ådnanes & Steihaug, 2013). In particular, transitions and collaboration between specialised and primary care have proved to be challenging (Bergmark et al, 2017;Bjørkquist & Hansen, 2018). There is an abundance of knowledge of specialised mental health services and clinical research (e.g.…”