[Integrating mental health and addiction services: the encounter of two worlds]

The needfor integrated services to treat co-occurring disorders is now recognized. Specialised clinics have now been created for this purpose. This study analysed the integration process that occurred in a particular clinic in order to identify the strategies and means used and their overall impact.

We conducted a longitudinal case study. Data collection was based on three sources: semi-structured interviews, observations and documents. It took place over a period of 3years and covered the first 6 years of the clinic transformation process. We analysed data from a process perspective. The analysis was also validated by informants.

Our analysis shows that the pursuit of integration is associated with important challenges at various levels: patient populations, professional practices, structural framework, inter-organizational relationships. These challenges were encountered right from the creation of the clinic. Various strategies and approaches were used to reduce the tensions raised by these challenges and had a considerable impact on the integration process. However, our analysis reveals that integration is an ongoing process that is never completely achieved. In fact, challenges are never completely resolved, but tend to be transformed, raising new tensions to which members of the organization respond with new strategies and means to ensure a continuing integration process.

These resultsforce us to reconsider the integration of services, not as a fixed result but rather as an object of change emerging from a complex process with an unknown outcome. Four important implicationsfor practice are derived from these results.