A multi-agency evaluation of the Leeds Dual Diagnosis care co-ordination protocol

Achieving integrated treatment: a realist synthesis of service models and systems for co-existing serious mental health and substance use conditions

Approximately 30-50% of people with serious mental illness have co-existing drug or alcohol problems (COSMHAD), associated with adverse health and social care outcomes. UK guidelines advocate both co-occurring needs being met within mental health services, but uncertainty remains about how to operationalise this to improve outcomes. Various unevaluated service configurations exist in the UK. A realist synthesis was done to identify, test, and refine programme theories of how context shapes the mechanisms through which UK service models for COSMHAD work, for whom, and in what circumstances. Structured and iterative realist searches of seven databases identified 5099 records. A two-stage screening process identified 132 papers. Three broad contextual factors shaped COSMHAD services across 11 programme theories: committed leadership, clear expectations regarding COSMHAD from mental health and substance use workforces, and clear care-coordination processes. These contextual factors led to increased staff empathy, confidence, legitimisation, and multidisciplinary ethos, which improved care coordination and increased the motivation of people with COSMHAD to work towards their goals. Our synthesis highlights that integrating COSMHAD care is complex, and both individual and cultural behavioural shifts in leadership, workforce, and service delivery are essential to ensure people with COSMHAD receive compassionate, trauma-informed care that meets their needs.

Public response to the implementation of clean and healthy living behavior (PHBS) in coastal community in Rokan Hilir Regency

Purpose

This paper aims to find in-depth information related the activities of “clean and healthy behavior” in household regulations, starting from assessment, planning, mobilization, implementation monitoring and assessment.

Design/methodology/approach

Data analysis was used for quantitative and qualitative approaches (mixing method). The qualitative approach was used to understand the individual phenomena in terms of finding, obtaining and describing the community behavior, which is related to health problems. The data obtained through the approach were then analyzed using interactive model.

Findings

In principle, this research exactly determines the responses of officers and the community to the process of “clean and healthy living behavior” activities. In general, the health facility used first is self-treatment, before seeking medical treatment or non-drug treatment. It proves that humans are always experimenting. From the research result, there are respondents who do not use medical treatment at 16 per cent; and the remaining 84 per cent are using medical treatment, despite being preceded by self-treatment (S) and non-medical treatment (N).

Originality/value

Currently, there have not been many studies related to the implementation of clean and healthy behavior although the information about it is very important to know. The managers of the “clean and healthy behavior” program need to know such information.