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Improving management of comorbid substance use and mental illness with an integrated and stepped care approach

University of Sydney

  • Early-Mid Career Fellowship
Date Funded:
  • 1 February, 2017
Chief Investigator/s:
  • Dr. Kirsten Morley

Mental and substance use disorders account for more years of life lost due to disability than any other disorders and are second only to cardiovascular disease and cancer as leading causes of disease burden. Comorbidity of mental and substance use disorders pose a significant challenge for the Australian health system. The silo structure of the healthcare system has historically treated clients in parallel by different treatment providers. Typically, treatment is incomplete and outcomes are poor.

The NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) leads the way in new research examining innovative treatments for comorbidity. NSW health services provide a unique context into which new approaches to comorbidity treatment can be embedded. Our research has demonstrated that an integrated, stepped care (ISC) approach is ideal for optimal client outcomes and to avoid clients falling through the gaps.

Integrated care involves both substance use and the mental health condition being addressed by the same provider. This can be facilitated by a stepped approach where additional care is provided for a mental health diagnosis after stabilisation from substance use, enabling the distinction between substance-related mental health symptoms versus symptoms remaining or emerging once use has resolved.

This project aims to:

  1. Evaluate the impact of a Multi-modal Translation Intervention Package (MTP) to (a) increase ISC proficiency and uptake; (b) enhance clinician knowledge and attitudes; (c) improve substance use and mental health outcomes.
  2. Examine barriers and facilitators of ISC implementation using the MTP.
  3. Deliver MTP resources and sustainability recommendations to NSW Health for future rollout.
  4. Promote identification, assessment and clinical management of comorbidity within the drug and alcohol services of NSW local health districts.