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Implementing clinical guidelines for co-occurring substance use and major mental disorders in Swedish forensic psychiatry : An exploratory, qualitative interview study with mental health care staff

Green, J. ; Bagge, A. S.Lindqvist ; Olausson, S. ; Andiné, P. ; Wallinius, M. LU and Karlén, M. Hildebrand (2023) In Journal of Substance Abuse Treatment 144.
Abstract

Introduction: Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden. Methods: Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe... (More)

Introduction: Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden. Methods: Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff's experiences with these guidelines and suggestions for improvement. Results: Most participants reported appreciation for the implementation of clinical guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff's attitudes toward SUD. Participants' reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate. Conclusions: Despite indications of some ambivalence among staff regarding the necessity of the assessment and treatment guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the “gap” between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients' insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Clinical guidelines, Co-occurring diagnoses, Community reinforcement approach, Implementation, Substance use disorder, Thematic analysis
in
Journal of Substance Abuse Treatment
volume
144
article number
108899
publisher
Elsevier
external identifiers
  • scopus:85140328010
  • pmid:36270196
ISSN
0740-5472
DOI
10.1016/j.jsat.2022.108899
language
English
LU publication?
yes
id
521679dd-b5ce-4c19-bca4-636fbda6a70a
date added to LUP
2023-01-23 14:15:26
date last changed
2024-06-25 19:56:32
@article{521679dd-b5ce-4c19-bca4-636fbda6a70a,
  abstract     = {{<p>Introduction: Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden. Methods: Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff's experiences with these guidelines and suggestions for improvement. Results: Most participants reported appreciation for the implementation of clinical guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff's attitudes toward SUD. Participants' reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate. Conclusions: Despite indications of some ambivalence among staff regarding the necessity of the assessment and treatment guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the “gap” between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients' insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.</p>}},
  author       = {{Green, J. and Bagge, A. S.Lindqvist and Olausson, S. and Andiné, P. and Wallinius, M. and Karlén, M. Hildebrand}},
  issn         = {{0740-5472}},
  keywords     = {{Clinical guidelines; Co-occurring diagnoses; Community reinforcement approach; Implementation; Substance use disorder; Thematic analysis}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Substance Abuse Treatment}},
  title        = {{Implementing clinical guidelines for co-occurring substance use and major mental disorders in Swedish forensic psychiatry : An exploratory, qualitative interview study with mental health care staff}},
  url          = {{http://dx.doi.org/10.1016/j.jsat.2022.108899}},
  doi          = {{10.1016/j.jsat.2022.108899}},
  volume       = {{144}},
  year         = {{2023}},
}