7.2 What should happen: Integrated treatment

Outline - Chapter 7: Navigating the treatment system

• Is there a system?
• What should happen: Integrated treatment
• What may happen: Sequential or parallel treatment
• Access points
• Screening, assessment and diagnosis
• Treatment planning
• Treatment
• Treatment approaches
• Co-ordinating treatment
• Continuing care

Treatment for concurrent disorders works best if the client has a stable, trusting, long-term relationship with one health care professional—for example, a case manager or therapist.

Integrated treatment means that treatment for substance use and mental health problems are combined and ideally provided in the same treatment setting by the same clinicians and support workers, or same team of clinicians and support workers. This ensures that a client receives a consistent explanation of substance use and mental health problems and a coherent treatment plan. Integrated treatment means that the client gets co-ordinated and comprehensive treatment, as well as help in other life areas, such as ho using and employment. Ongoing support in these life areas helps clients to maintain treatment successes, prevent relapses and meet their basic life needs.

Most integrated programs have been developed for clients who have severe mental health problems. They have common features including:

• staged interventions (see “States of change” and “Stages of treatment” in the Treatment section)
• assertive outreach (see “Assertive community treatment,” in the Co-ordinating Treatment section)
• motivational interventions (see “Motivational approaches to treatment,” in the Treatment section)
• social support interventions (e.g., housing and employment support).

If integrated care always required that clients be served in a single program, current service systems would have to be completely rebuilt. Fortunately, substance use and mental health service providers are discovering that many people with concurrent disorders can receive well-integrated care from different programs, if:

• links are established among programs
• one person or team takes overall responsibility for ensuring that services are co-ordinated.

Many substance use and mental health service providers have developed collaborative relationships that allow them to offer integrated approaches to treating concurrent disorders.

People with severe mental illness and substance use problems usually respond better when both problems are treated at the same time. However, people with other types of mental health problems may respond better when substance use and mental health problems are treated in sequence (e.g., anxiety problems often improve when substance use is reduced or stopped). In this example, substance use problems are usually addressed first, but within the context of a treatment plan that considers both mental health and substance use problems (Health Canada, 2002).

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