Sustaining treatment of vulnerable people: assessing needs for integrated care in mental health

BACKGROUND: About half the population in Denmark will experience mental health challenges during their lives. Among them a group of vulnerable people often experiences higher unmet needs and lack of coherence between sectors. They therefore require cross-sectoral initiatives. The Flexible Assertive Community Treatment (FACT) model offers integrated healthcare access to people with severe mental illness, through interprofessional teams across health and social services. The model is implemented in Central Denmark Region between the specialist (regional) and the (municipal) community mental health services. This study aimed to explore the pathways through the healthcare system of citizens with severe mental illness, and to analyze the abilities of provider organizations to meet the needs of the target group. METHODS: The study draws on interviews and observations with participants of FACT that suffer from severe mental illness, interviews with the health and social care professionals involved, and observations of interactions between the two groups of informants. RESULTS: The participants of FACT experienced smoother pathways between the regional and municipal sectors and more integrated access to services, as they had only one gateway instead of several. They further experienced closer relations with and between the professionals in the FACT teams (e.g., psychiatrists, community and social workers, nurses). These professionals to a larger extent understood and pursued the participants’ individual needs. This created for example higher levels of trust and contributed to the sustainment of the participants in treatment. CONCLUSIONS: People with severe mental illness struggle to cope with many different aspects of life, including navigating the health system and sustaining treatment. To retain this vulnerable group in treatment it is key that health systems provide continuous and integrated treatment that meets individual needs. KEY MESSAGES: • The current study finds that FACT provides valuable tools to offer integrated and person-centered care for people suffering from severe mental illness. • The current study finds that FACT provides valuable tools to offer integrated and person-centered care for people suffering from severe mental illness.