Accessability of mental health services for people with substance use: findings from the SUMHIT project
Background: Many people with Substance Use Disorders (SUB) have additional Mental Health Care (MHC) problems, while many people with MHC problems also use substances. In Belgium, as in many countries, specialized SUB developed as a segregated sector in parallel with mental health care (MHC). 2010 MHC reforms enabled the creation of care networks, which should offer a coherent set of services and seamless care pathways for all kinds of MHC problems. Nevertheless, in 2019 the Belgian Healthcare Knowledge Centre (KCE) still pointed to a lack of accessibility to appropriate care services for clients with SUB and MHC problems. The aim of this study is to gain insight into the experiences of persons with SUB regarding the accessibility towards MHC.
Methods: Qualitative semi-structured interviews (n=50) in five different Belgian regions were used to identify barriers clients experience in accessing the care services they ideally need. Thematic analysis was used to identify common or overarching themes, ideas and patterns.
Results: Preliminary results indicate that clients experience thresholds at various echelon. At social level, where the stigma on both MHC and substance use plays a strong role but also within and between the structure of both health and welfare sectors. At the level of the private organization, clients sometimes notice practical barriers and the judgmental way towards substance use. Finally factors at the level of the environmental system around the client and the impact of peers are retained.
Conclusion: To be able to lower the threshold of access to MHC services for people with SUB, a structural approach that transcends the individual organisation, will be paramount. Within the treatment and follow-up, the focus should not only be on the SUB itself, but also on support in all areas of life, aiming at maximum quality of life. This will require a comprehensive network-oriented approach in which coordination will be crucial.