Service Use and Unmet Needs for Substance Use and Mental Disorders in Canada

Urbanoski, Karen; Inglis, Dakota; Veldhuizen, Scott

doi:10.1177/0706743717714467

Cited by 93 publications

(89 citation statements)

References 39 publications

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“…Our findings are consistent with general population surveys reporting that, among people with co-occurring disorders, more accessed specialty mental health than specialty substance use care (Han et al, 2017; Ubanoski et al, 2017). Regarding reasons that relatively low proportions of patients received specialty substance use care, other studies found that inpatient psychiatry staff members often report negative attitudes toward patients with co-occurring disorders, have a lack of training in how to address substance use, difficulty in accessing supervisors with such training, and that poor communication and coordination exist between inpatient psychiatry and outpatient substance use treatment settings (Danda, 2012; Howard & Holmshaw, 2010).…”

Section: Discussionsupporting

confidence: 90%

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

Timko

Harris

Jannausch

et al. 2019

Drug and Alcohol Dependence

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Background: Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders. Methods: This randomized controlled trial (n=406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (3 months post-baseline) and 9 and 15 months post-baseline (73% followed). Primary outcomes were number of days, out of the past 30, of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization. Results: Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition. Conclusions: Among these patients, improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes.

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Section: Discussionsupporting

confidence: 90%

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

Timko

Harris

Jannausch

et al. 2019

Drug and Alcohol Dependence

View full text Add to dashboard Cite

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“…Despite these limitations and contextual remarks, we can conclude that our ndings are in line with those of epidemiological studies. According to our participants, UMHNs are most prevalent in vulnerable groups such as people living in poverty, ethnic minorities, and in the young and old age groups (11,21,22).…”

Section: Discussionmentioning

confidence: 95%

“…Vulnerable groups are generally more likely to underuse or experience access barriers to health care, resulting in high levels of UMHNs (20). Groups with a high level of UMHNs include the young and the elderly, ethnic or cultural minorities, people with poorer health and people with lower income (11,(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

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Unmet mental health needs in the general population: perspectives of Belgian health and social care professionals

Rens

Dom

Remmen

et al. 2020

Preprint

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Background: An unmet mental health need exists when someone has a mental health problem but does not receive formal care, or when the care received is insufficient or inadequate. Epidemiological research has identified both structural and attitudinal barriers to care which lead to unmet mental health needs, but reviewed literature has shown gaps in qualitative research on unmet mental health needs. This study aimed to explore unmet mental health needs in the general population from the perspective of professionals working with vulnerable groups.Methods: Four focus group discussions and two interviews with 34 participants were conducted from October 2019 to January 2020. Participants’ professional backgrounds encompassed social work, mental health care and primary care in one rural and one urban primary care zone in Antwerp, Belgium. A topic guide was used to prompt discussions about which groups have high unmet mental health needs and why. Transcripts were coded using thematic analysis.Results: Five themes emerged, which are subdivided in several subthemes: (1) socio-demographic determinants and disorder characteristics associated with unmet mental health needs; (2) demand-side barriers; (3) supply-side barriers; (4) consequences of unmet mental health needs; and (5) suggested improvements for meeting unmet mental health needs.Conclusions: While findings of epidemiological research were largely corroborated, some additional groups and factors associated with unmet needs were identified. Professionals argued that they are often confronted with cases which are too complex for regular psychiatric care and highlighted the problem of care avoidance. Important system-level factors include waiting times of subsidized services and costs of non-subsidized services. As a result, feelings of burden and powerlessness are common among professionals. Professionals discussed future directions for an equitable mental health care provision, which should be accessible and targeted at those in the greatest need. Further research is needed to include the patients’ perspective of unmet mental health needs.

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“…Despite the well-recognized treatment gap and barriers to treatment, the individuals with comorbid problems seem to be more frequent users of all types of medical services [8,13,14]. The individuals with both disorders had, for example, multiple visits to emergency departments [8] and increased rates of psychiatric hospitalisation [15,16].…”

Section: Introductionmentioning

confidence: 99%

Mental health problems among clients with substance use problems: a nationwide time-trend study

Kuussaari

Karjalainen

Niemelä

2019

Soc Psychiatry Psychiatr Epidemiol

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Purpose Mental health and substance use disorders are notable contributors to the global total burden of disease. On a population level, co-occurring mental health and substance use problems are estimated to account for 2-4%. In clinical samples, estimate is even higher. The aim of this study was to examine changes in recognized mental health problems (MHPs) and in the substance use profiles among clients with substance use problems in Finland. Methods Data concerning individuals with substance use entering Finnish social and health care services during 1 day were collected nationwide at three time-points in 2007, 2011, and 2015. Cross-tabulations and logistic regression were used for statistical analysis. Results Co-occurring MHPs and substance use problems were common: 56-60% of the clients with substance use problems were reported to have had MHPs between the years 2007 and 2015. The proportion of MHPs remained rather stable among them. Substance use profiles have changed: the proportion of illicit drug use among those who had MHPs has increased in health care services, social services, and substance use problem services. Conclusion Co-occurring substance use and MHPs among clients with substance use problems are common, and substance use profile is shifting from using alcohol only towards illicit drug use. This may even bring along more challenges for the treatment system and should be considered in future service planning.

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Service Use and Unmet Needs for Substance Use and Mental Disorders in Canada

Cited by 93 publications

References 39 publications

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

Unmet mental health needs in the general population: perspectives of Belgian health and social care professionals

Mental health problems among clients with substance use problems: a nationwide time-trend study

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