The management of comorbid mental health and substance use problems in nursing practice

Abstract

Introduction: Comorbid mental health and substance use problems are prevalent, posing challenges for health professionals. Despite the proven effectiveness of integrated care, its adoption in mental health and drug health services remains limited. Nurses, a key part of the public health workforce, play a critical role in delivering care for comorbidities. This project explored nurses' perspectives on managing comorbidity and implementing integrated care, with findings aimed at informing a tailored training program.

Design and Methods: Two aims guided the project: (1) understanding nurses' attitudes and perceptions of comorbidity management through a systematic review, and (2) assessing gaps in nursing practice via a needs assessment. The systematic review, following PRISMA-P guidelines, addressed nurses’ views on substance use, their roles in managing comorbidities, and factors influencing attitudes. The needs assessment used a mixed methods approach and the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators of integrated care.

Results: The systematic review identified mixed attitudes across four themes: (i) views on substance use among mental health consumers, (ii) attitudes towards comorbid care, (iii) role perceptions, and (iv) treatment optimism. Negative beliefs about substance use and low willingness to engage in care were common. The needs assessment echoed these findings, highlighting system-level barriers over individual factors. Nurses stressed the need for organizational support and leadership to enable training and implementation.

Discussion and Conclusion: Implementing evidence-based practices like integrated care is complex and influenced by clinicians’ attitudes. Programs such as Pathways to Comorbidity Care (PCC) show promise in improving competency and treatment optimism. Frameworks like CFIR can help mental health services address barriers and strengthen facilitators for successful implementation.