Identifying challenges in concurrent mental health and substance use disorder care: qualitative findings from an e-Delphi study in British Columbia, Canada

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. 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. 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. 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.