I09 – Scoping Review: State of and Movement Towards Continuum of integrated MentalHealth and Substance Use Services and Systems

Summary

Intro: Mental health (MH), substance use (SU) and concurrent MHSU disorders are highly prevalent in the United States and Canada, carry significant health, social, and economic expenditures and are challenging to address. Although recent efforts have been made to integrate MH and SU care at the provincial, state, and territorial policy level, innovations at the service delivery level are often not reflected in macro policy frameworks and vice-versa. Additionally, the best available evidence and guidance on what models and interventions work best for which populations, geospatial needs, and service providers is incomplete or lacking. Objectives: We conducted a scoping review to examine the latest evidence on nature, types and benefits of MHSU integration efforts at service, system, and policy levels. We sought to identify what configurations of MHSU integrated services work best for which populations, based on psychiatric, medical co-morbidities, psychosocial needs, ethnic, geographic backgrounds, settings, and cultural factors. Methodology: Literature was identified with an expert advisory committee and librarian scientist. Searches of 5 databases including PubMed, PsycINFO, and CINAHL. After initial screening of abstracts and titles, authors independently reviewed the full text of articles. All points of discrepancy were resolved by discussion and consensus. Articles published between 2018 and 2021, which primarily addressed MH and/or SU concerns across prevention, treatment, intervention, service, system, and policy levels were included for analysis. Results: From 417 initial titles, 333 were selected for full-text review, and 217 were included for data extraction and synthesis. We will present 1) where and how the latest evidence supports the integration of MHSU care; 2) barriers and facilitators to integrated MHSU care at the service, system, and policy levels, 3) how equity and diversity can be further foregrounded to better address impacts on specific populations and 4) provide key recommendations for research and policy. Extent literature highlights the emerging role of innovative e-mental health technology, stepped care models, the increasing foregrounding of need for implementation science approaches to fill evidence to practice gaps, the advancing role of public health interventions, while elucidating mechanisms needed to support integrated health and social care interventions, culturally safe, community health workers, nurses, care managers, psychologists and persons with lived and living experience into the MHSU workforce. Conclusions: Our scoping review provides comprehensive evidence on the nature, type, and populations benefiting from MHSU integration, with special attention given to settings, groups, and contexts most actively considered as well as those requiring further research and policy support.