This project addresses one of the most difficult questions in the modern welfare state: how to organize services for people with concurrent addiction and mental health problems, also referred to as dual diagnosis, in ways that make these services more coordinated. People with dual diagnosis are characterized by having long-lasting and complex problems, not compatible with linear models of coordination. Improving services for this target group is a highly prioritized aim in the service organizations and education of health and welfare professions as well. There is a need for flexible structures, coordination mechanisms and multi-professional approaches. The project has mapped how service provision for the target group is developed and organized in three municipalities.
The organizational and professional perspectives on addiction and mental health services have changed. We find that there are three characteristics in the development of local organization of services for people with complex challenges that provide a framework for service development, namely decentralization, user participation and coordination. These characteristics may be understood as entangled processes in the emergence of a «new paradigm» in the services: a focus on «local-based services».
The local change processes we have studied show that institutional characteristics, based on different history and traditions in the work with addiction and mental health problems, are important for understanding how the change processes are organized. The three municipalities we have studied all recognize that addiction and mental health challenges are important societal problems, which must be addressed locally. At the same time, we can state that the local strategies for achieving the goal of better coordination and integrated services, which is in line with national goals take place in very different ways. Still, local organization of service provision for the patient group are extensively varied, in accordance with the decentralized structure of mental health and addiction policies in the country.
Furthermore, a research-based teaching program is developed. The teaching program aims to disseminate knowledge on how integrated services are created. The target group is bachelor students, master's students and/or employees in the services.
Results are presented at national and international conferences and journals as well as in the book (in Norwegian) (National Policies and Local Challenges. Organizing Addiction and Mental Health Services). The project held a final conference where the book was presented and where national and international researchers presented their research on integrated services for people with addiction and mental illness.
ROPIT-prosjektet har formidlet hvordan samfunnsvitenskapelige perspektiver kan bidra til forståelsen av mekanismer som hindrer bedre samordning i tjenestesystemet for rus og psykiske lidelser, og peker på mulige løsninger i endringsprosessene. Det er identifisert felles utfordringene med å realisere mål om integrerte tjenester i kommunene som deltok i prosjektet, men løsningene varierer.
Som et ledd i arbeidet med å utvikle kompetansen om tjenester på ROP-feltet, har prosjektet utviklet et kort, fleksibelt kurs om organisering av tiltak og tjenester som kan tilbys brukerorganisasjoner, tjenesteytere og ledere.
Prosjektets deltakere har fått økt kompetanse, prosjektleder er tilkjent professorkompetanse, en prosjektdeltakerne forventes så søke professoropprykk i løpet av kort tid og stipendiaten vil inngå i staben med førstekompetanse etter prosjektslutt. Prosjektdeltakerne har bidratt med felles publiseringer i tidsskrifter og en antologi og i ulike faglige fora innen feltet.
This project addresses one of the most difficult questions in the modern welfare state: how to organize services for people with concurrent addiction and mental health problems in ways that make these services more coordinated as seen by the users. Improving services for this patient group is a highly prioritized aim in the service organizations and in education of health and welfare professions as well. These users/patients are characterized by long lasting and complex problems, not compatible to linear models of coordination. There is a need for flexible structures, coordination mechanisms and multiprofessional approaches. Building upon the experiences from users, service providers and international researchers, we intend to extend knowledge on how to improve the relevant services and design models of interprofessional teaching, adopting an organization theory approach. Scientifically sound knowledge of organizing services for this patient group is a field that has been largely neglected and under-researched. The project is based upon an explicit service organization analytical model design, and will be organized with three local services (in three municipalities). The strategy of dissemination includes a teaching strategy to be tested/implemented in bachelor and master studies in addition to publishing the results in national/international journals/books. The participants behind this proposal have extensive experience as users, service providers and in research and teaching.