Islands in the stream: The accessibility of mental health care for persons with substance use problems in Belgium
Background – In Belgium, services targeting persons with substance use problems have historically largely been developed as a separate sector to general mental health care. Due to this division, persons with substance use problems often fail to access support tailored to their complex and long-term needs. The SUMHIT (Substance Use and Mental Health care InTegration) project aims to study the place of persons with substance use problems in Belgian mental health care and the collaboration of mental health care and specialized addiction treatment services. The presented qualitative sub-study focused on the lived experiences of persons with substance use problems and unraveled the underlying dynamics impacting the accessibility of mental health care services.
Methods – Data were collected by means of in-depth interviews with a heterogeneous sample (n=52) of persons with substance use problems, including both persons who do and do not have access to services, recruited from five regional mental health networks. Interviews were analyzed thematically.
Results – Five dynamic themes influencing the accessibility of mental health care for persons with substance use problems came to the fore: (1) fragmentation of care and support, (2) the importance of “really listening”, (3) balancing between treatment-driven and person-centered support, (4) the ambivalent role of peers, and (5) the impact of stigma.
Discussion – Despite the recent mental health reform (Article 107) in Belgium aiming to enhance collaborations between services, enhance care continuity and provide more adequate recovery-oriented support, services within the mental health care landscape are still experienced as ‘islands in the stream’ by service-users with substance use problems. To transform mental health care networks from to more cohesive and collaborative ecosystems, the following aspects: (1) breaking the vicious cycles of waiting times, (2) organizing relational case management, (3) tackling stigma and centralizing lived experience, and (4) fostering recovery-promoting collaborations. During the presentation, these points will be critically discussed.
