Organising housing and service provision for persons with co-occurring substance use and mental health problems: a...

Persons with co-occurring disorders, both substance use and mental health problems (COP) may be encountered within various disciplinary systems and organisational levels of treatment. In western countries, the most common evidence-based housing programme for persons with complex, long-term needs due to severe mental illness and substance use is Housing First. The context of this study were the Nordic countries, granting universal access to treatment and free public services. The aim was to examine how multidisciplinary and integrated housing services are organised and coordinated for persons with COP.

We conducted a systematic search for literature in six databases (i.e. CINAHL, Ovid, SocINDEX, Web of Science, Scopus, and Social Services Abstracts), along with manual searches. After blinded review by two authors in Rayyan, the full texts of 75 articles were reviewed for inclusion, the quality of the selected research articles was completed according to checklists from the Joanna Briggs Institute. A thematic analysis of nine articles was completed according to a coding scheme.

From the Nordic perspective, introduced as a model in this article, regions need to develop the organisation and the workforce skills of health and social services as an integrated whole, with special focus on defining responsibilities at different levels, maintaining and improving relationships within a multidisciplinary, integrated, comprehensive, and community-based system of care inclusive of housing services. Supporting the recovery of persons with COP means giving them a voice and having professionals skilled in COP aid them.

The approach of emphasizing primary care and multidisciplinary mental health is yet today a challenge even in high-income areas. The integration of services was not on an ideal level, even though the housing policies were rights-based. We identified societal responsibilities stemming from national policies. It is possible that functional integration does not take place in all regions. As the working methods were based on active relationship building to be able to help persons with COP, we interpreted this as a sign of clinical integration. The recommendations for the organisation and coordination of services for persons with COP include ensuring the right to a home, ensuring social integration and community involvement, combatting stigma, and systemising user involvement. There are research gaps in all Nordic countries and the research within housing for persons with COP is scarce. We call for using multi-dimensional research approaches.

Not applicable.