Service integration: The perspective of Australian alcohol and other drug (AOD) nurses

Integrating Substance Misuse Specialists in a Youth Early Psychosis Service: Increasing Mental Health Clinicians' Knowledge and Confidence

Substance misuse and mental health disorders are commonly occurring co-morbidities in young people. This paper reports on a pilot project to embed three specialist Alcohol and Other Drug (AoD) workers to be embedded in a youth early psychosis service to upskill mental health clinicians in managing substance misuse. Evaluation of the project used a mixed methods approach. Quantitative results showed that clinical staff members' knowledge of substance misuse, knowledge of AoD treatments and services, and overall confidence in working with young people with a substance misuse issue improved following implementation of the project. Qualitative results indicated four themes which emerged: defining the role of the AoD workers; support and upskilling of the mental health staff; openness and effective communication between the embedded workers and mental health teams; and barriers to collaboration. The results provide support for the embedding of specialist alcohol and drug workers in youth mental health services.

"I thought it would just be, like, older men in white coats": A qualitative exploration of first encounters with mental health services

Individuals whose mental health is becoming a concern may not receive the care they require. Although efforts have been made to reduce barriers to accessing services, including stigma reduction campaigns and healthcare practitioner training, there remains a lack of understanding of individual perspectives regarding help-seeking behaviour. The aim of this study was to explore people's first experiences accessing mental health services. A qualitative descriptive approach was adopted. Interviews were conducted with eight service users. Data were analysed using reflexive thematic analysis. The COREQ checklist guided this study (Tong et al., 2007, International Journal for Quality in Health Care, 19, 349). Three themes were identified: learning to navigate an unfamiliar system, making sense of mental health services, and promoting a positive image for those in need of care. Uncertainty about mental health services and stigmatizing images could be mitigated by developing positive media-based interventions. Systemic barriers need to be addressed and services need to be better resourced to ensure the benefits of early intervention are available to those experiencing mental health challenges. To encourage people to access services earlier, services need to be promoted in a positive way.

Integrated nursing care for people with combined mental health and substance use disorders

Many health problems arise from mental, neurological, and substance use disorders. These disorders are highly prevalent and complex and contribute to poor health outcomes, premature mortality, security risk, social isolation, and global and national economic loss. Mental health and substance use disorders are among Australia's top four causes of disease burden. Our objective was to investigate and synthesize contemporary literature regarding factors that influence nurses' delivery of integrated care to people with combined mental health and substance use disorders within mental health services. We systematically searched five electronic databases with a limit on publications from 2009 to 2021. The search yielded 26 articles. Following thematic analysis, three themes were identified: individual nursing characteristics, nursing education, and professional development characteristics, and organizational factors. This study reveals that there is a fundamental absence of adequate integrative models of care within mental health services to enable the optimal nursing care of people with combined mental health and substance use disorders. Future research is needed to determine nurses' perceptions and factors influencing their role as participants in integrative care. The results could strengthen nurses' contributions in developing/adopting integrative models of care and contribute to clinical, educational, and organizational development.

Social work in alcohol and other drug service navigation: supporting social complexity in dual diagnosis

Purpose

Many people with dual diagnosis present with social complexity that impedes service access. The role of social work support in such service navigation is poorly understood. This study aims to characterise client presentations to an Australian telephone-based social work alcohol and other drug (AOD) service navigation and linkage program, with consideration of presentation complexity compared between those clients who present with or without self-reported mental health (MH) concerns and a history of MH diagnoses, to identify differences in baseline characteristics, and linkage outcomes.

Design/methodology/approach

A retrospective audit was conducted of routinely collected clinical information from a six-month period, selected to capture the social and health challenges experienced during the mid-pandemic period (mid-2021) in Victoria, Australia, during which a number of lockdowns resulted in a reliance on telephone-based services. The audit focused on client and presentation characteristics, and compared clients with and without a history of co-occurring MH and AOD concerns.

Findings

It was found that three in four people accessing an Australian telephone-based AOD service navigation and linkage program presented with dual diagnosis. Individuals with dual diagnosis required more support from the service compared to those without a co-occurring MH disorder; but overall, were just as likely to achieve a successful linkage to services, when offered holistic, long-term social work support.

Originality/value

This study focused on the role of social workers in this service navigation program in supporting individuals with complexity. It also highlights the challenges in operationalising social complexity factors alongside clinical MH and AOD diagnoses, and points to the need for further research to guide future service development for this vulnerable client group.