TY - JOUR
AU - I. Cheung
AU - M. Carter
AU - E. Dogherty
AU - T. Goodyear
AU - A. Russolillo
A1 - 
AB - BACKGROUND: Health care for people with co-occurring mental health and substance use disorders (i.e., concurrent disorders) has been described as fragmented and uncoordinated. Despite evidence that integrated care is associated with improved health and social outcomes, siloed health services continue to dominate the health system. Absent from the discourse around meaningful system improvements are the perspectives of people with lived/living experience and those with heath professional experience. This study aimed to explore the health care experiences of people with concurrent disorders, as well as the perspectives of health care providers, and identify recommendations for improvements in policy and practice. METHODS: A modified online e-Delphi study was conducted to reach consensus on the most important elements of integrated and recovery-oriented care for people with concurrent disorders. Data were collected between May 2022 and June 2023 across three iterative rounds. This analysis focuses on qualitative responses from Round 2 where participants (N = 13) responded to open-ended questions about current challenges in mental health and substance use care. Data were coded and analyzed using an inductive, reflexive thematic approach. RESULTS: We developed four main themes describing participant challenges with existing mental health and substance use care: high-barrier services, lack of integration, need for person-centred care, and the importance of prioritizing voices of people with lived/living experience of concurrent disorders. Recommendations for change were identified for each theme and represented across micro, meso, and macro levels. CONCLUSIONS: Providers and people with lived and living experience identified structural and systemic issues in concurrent disorder care and recommended changes to address several gaps in care and service delivery. Findings underscore the need to improve concurrent disorder care access and address upstream opportunities and system-level barriers to treatment access. Future research should examine how the implementation of these recommendations influence service accessibility, treatment outcomes, and health equity.
AD - Mental Health Program, Providence Health Care, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.; School of Nursing, University of British Columbia, Gateway Health Building, 5955 University Blvd, Room 5247, Vancouver, BC, V6T 1Z1, Canada.; Urban Health & Substance Use Program, Providence Health Care, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.; School of Nursing, University of British Columbia, Gateway Health Building, 5955 University Blvd, Room 5247, Vancouver, BC, V6T 1Z1, Canada. angela.russolillo@ubc.ca.
AN - 42015189
BT - BMC Health Serv Res
C5 - Opioids & Substance Use
CP - 1
DA - 04/2026
DO - 10.1186/s12913-026-14535-w
DP - NLM
ET - 20260421
IS - 1
JF - BMC Health Serv Res
LA - eng
N2 - BACKGROUND: Health care for people with co-occurring mental health and substance use disorders (i.e., concurrent disorders) has been described as fragmented and uncoordinated. Despite evidence that integrated care is associated with improved health and social outcomes, siloed health services continue to dominate the health system. Absent from the discourse around meaningful system improvements are the perspectives of people with lived/living experience and those with heath professional experience. This study aimed to explore the health care experiences of people with concurrent disorders, as well as the perspectives of health care providers, and identify recommendations for improvements in policy and practice. METHODS: A modified online e-Delphi study was conducted to reach consensus on the most important elements of integrated and recovery-oriented care for people with concurrent disorders. Data were collected between May 2022 and June 2023 across three iterative rounds. This analysis focuses on qualitative responses from Round 2 where participants (N = 13) responded to open-ended questions about current challenges in mental health and substance use care. Data were coded and analyzed using an inductive, reflexive thematic approach. RESULTS: We developed four main themes describing participant challenges with existing mental health and substance use care: high-barrier services, lack of integration, need for person-centred care, and the importance of prioritizing voices of people with lived/living experience of concurrent disorders. Recommendations for change were identified for each theme and represented across micro, meso, and macro levels. CONCLUSIONS: Providers and people with lived and living experience identified structural and systemic issues in concurrent disorder care and recommended changes to address several gaps in care and service delivery. Findings underscore the need to improve concurrent disorder care access and address upstream opportunities and system-level barriers to treatment access. Future research should examine how the implementation of these recommendations influence service accessibility, treatment outcomes, and health equity.
PY - 2026
SN - 1472-6963
ST - Identifying challenges in concurrent mental health and substance use disorder care: qualitative findings from an e-Delphi study in British Columbia, Canada
T1 - Identifying challenges in concurrent mental health and substance use disorder care: qualitative findings from an e-Delphi study in British Columbia, Canada
T2 - BMC Health Serv Res
TI - Identifying challenges in concurrent mental health and substance use disorder care: qualitative findings from an e-Delphi study in British Columbia, Canada
U1 - Opioids & Substance Use
U3 - 10.1186/s12913-026-14535-w
VL - 26
VO - 1472-6963
Y1 - 2026
ER -