Document 3:5 (2024−2025) / Published Health and welfare services for people with co-occurring substance use and mental health disorders
The authorities have not ensured that people with mental health disorders combined with substance use disorders get the help they need. This may have serious consequences for the individual, their families and society at large.
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(PDF, 3.65 MB)
The pdf is in Norwegian
Background
People with severe co-occurring substance use and mental health disorders have many and complex needs. They require various services from different service providers, and these services must be both flexible and adapted to their needs.
The government's escalation plan for the field of drugs and addiction (2016–2020) had three priority areas: early intervention, treatment and follow-up services.
The overall goal of the escalation plan for mental health (2023–2033) is for more people to enjoy good mental health and a good quality of life, and for those in need of mental health care to have access to good, readily available assistance.
Overall assessment
It is highly objectionable that:
- the Ministry of Health and Care Services and the Ministry of Labour and Social Inclusion have not done enough to ensure that people with co-occurring substance use and mental health disorders receive the help they need in the form of treatment, activity and follow-up
- collaboration between the services does not work as intended – inadequate treatment in this case can have particularly severe consequences for both the individual and society at large
Conclusions
At present, neither the health services, social housing services, work-oriented rehabilitation nor other meaningful activity provision are flexible or adapted for this vulnerable group. There is a lack of coordination between the different services, and the services they in turn offer are often fragmented.
Services that are flexible and adapted to the needs of these people include outreach teams, inpatient mental health care, Individual Placement and Support and Housing First, a model that successfully combines housing, services and user participation.
However, these services are often not available, and have limited capacity where they are available.
- The health services have not done enough to adapt health care for people with severe co-occurring substance use and mental health disorders.
- The municipalities are often unable to provide suitable housing for this group.
- Work-oriented rehabilitation and activity measures are inadequately adapted.
- Poor collaboration between services and service levels leads to failures in the follow-up of people with co-occurring substance use and mental health disorders.
- The services do not adequately involve and support next of kin.
Recommendations
Services must be better adapted to the individual needs of people with co-occurring substance use and mental health disorders, and the authorities must ensure that adapted services are available and have the capacity to meet their needs. A comprehensive approach that includes health care, housing, work or other meaningful activity, is essential to providing good services.
We recommend that the Ministry of Health and Care Services, as part of its governance of the regional health enterprises, ensures that:
- these patients receive treatment that is specialised and simultaneous when necessary
- the experiences of patients and next of kin are obtained and used to improve services
- treatment services in mental health care are more geared towards identifying and treating disorders
- the downscaling of inpatient mental health care treatment is halted
We recommend that the Ministry of Labour and Social Inclusion ensures that the Norwegian Labour and Welfare Service (Nav) makes it easier for people with co-occurring substance use and mental health disorders to benefit more from Nav’s work-oriented measures and services, with a view to activity or necessary work assessment.
We recommend that the Ministry of Local Government and Regional Development consider how the Norwegian State Housing Bank can use its policy instruments to better assist municipalities in their efforts to secure more suitable housing for people with co-occurring substance use and mental health disorders.
We recommend that the Ministry of Health and Care Services and the Ministry of Labour and Social Inclusion:
- consider expanding the Individual Placement and Support service to more locations and making it more accessible and long-term
- Placement and Support service
We recommend that the Ministry of Health and Care Services, the Ministry of Labour and Social Inclusion, and the Ministry of Local Government and Regional Development facilitate collaboration between the services so that people with co-occurring substance use and mental health disorders receive the health and welfare services they need in a comprehensive and coordinated manner.