Care integration and recovery-orientation in Belgian mental health and addiction service networks

Introduction

Mental health comorbidity is widespread in people with substance use disorders. However, generic mental health and specialized addiction care services are not necessarily integrated despite organisational mechanisms that aim to support such integration. Personal recovery is an evidence-based approach to care in both fields that could favour more integration. Therefore, we assessed the structure of relationships existing between mental health and addiction services within five Belgian mental healthcare networks and explored the orientation towards personal recovery of network key services in terms of linkage and coordination.



Methods

An online survey was used with 194 services in five mental healthcare networks in Belgium. Data on referrals between services was collected. In addition, the survey included the Recovery Self-Assessment Scale for providers to measure the recovery orientation of services, as well as information on organisation characteristics. Social Network Analysis was applied to identify network structural and composition properties and assess the structural position of recovery-oriented services.



Results

The five networks differed in terms of size, linkage, and centrality. Both service types, i.e. mental healthcare and addiction, tended to have homophilous relationships, i.e. favouring relations with services from their own sector. The global level of service recovery orientation remained low, but was higher in specialized addiction than in generic mental healthcare services. Recovery orientation was also lower in inpatient services, especially regarding long-term facilities. These services, however, had higher centrality, indicating a favourable position for coordination.



Conclusion

All mental healthcare service networks may not be well adapted for care to people using substances within a personal recovery approach due to their structural differences. In particular, whilst there is a need for more collaboration between generic mental health and specialized addiction services, services in a coordination position are less oriented towards personal recovery.