Integrated Health and Social Services for People With Chronic Mental Health Problems: People Are More Important Than Processes. Insights From a Multiple Case Study in Swedish Psychiatry

Experiences of cross-sectoral collaboration between social security service and healthcare service for patients with chronic pain - a qualitative study

OBJECTIVES

Patients with chronic pain need healthcare services for pain management. Many also require social security services due to potential negative influence of chronic pain on social and work-related issues. The aim of this study was therefore to investigate the experiences of taking part in cross-sectoral collaborative meetings between social security service and healthcare service for chronic pain patients.

METHODS

A qualitative study using semi-structured individual interviews with 15 informants, including healthcare providers, patients, and social security supervisors who had taken part in 8 different meetings, was conducted. The focus of the interviews was how the informants experienced cross-sectoral collaborative meetings. The data were analyzed following the systematic text condensation method, including the steps of total impression, identifying meaning units, condensation, and synthesizing.

RESULTS

The findings were categorized into four themes: "Joining the meeting with preconceptions," which showed how some informants experienced that negative preconceptions toward the social security service were addressed in the cross-sectoral collaborative meetings and solved in some cases. "Get to know each other," which highlighted that the meetings provided opportunities for participants to increase their knowledge about the involved actors. "Access to detailed health information?" indicated that although concerns about whether sensitive health information should be shared with social security supervisors were raised by healthcare providers, the supervisors found this issue to be less concerning. Finally, "Who has the final word?", which showed that unclarity over decision-making processes during the meetings was experienced to create disagreement between participants.

CONCLUSIONS

The informants experienced that cross-sectoral collaborative meetings between patients, social security supervisors, and healthcare providers, while challenging, can play a significant role in managing the needs of patients with chronic pain. The study highlights the need for clarification over the roles of the actors and a jointly agreed-upon agenda for the meetings to ensure effective collaboration.

Exploring stakeholders' perceived problems associated with the care and support of children and youth with mental ill health in Sweden: a qualitative study

BACKGROUND

Care and support for children and youth with mental ill health have become more specialized and are provided by an increasing number of stakeholders. As a result, services are often fragmented, inefficient and unco-ordinated, with negative consequences for the service user and their family. Enhanced collaboration could lead to improved care and support but requires a shared understanding and a joint problem formulation between involved stakeholders to commence. The aim of this study was to explore different stakeholders' perceived problems associated with delivering care and support to children and youth with mental ill health and to discuss how the perceived problems relate to collaboration.

METHODS

A qualitative descriptive study was conducted, using short statements of perceived problems written by stakeholders involved in the care and support of children and youth with mental ill health during an inter-organizational workshop. The 26 stakeholders represented school and student health, primary health care, specialist care, social services, and different service user organizations. Data were collected during February 2020. Inductive content analysis with a summative approach was used when analysing the data.

RESULTS

The perceived problems were summarized in a model consisting of four main categories: Resources and governance; Collaboration and co-ordination; Knowledge and competence; and Stigma and confidence, containing 24 subcategories. These categories and subcategories were distributed over three levels: Societal level, Organizational level and Individual level. The perceived problems were shared on the category level but to some extent varied between stakeholder groups on the subcategory level. The perceived problems were either directly or indirectly related to collaboration.

CONCLUSIONS

The perceived problems often acted as barriers to achieving successful collaboration. The problems were distributed on all three levels in the developed model, indicating a complex problem. Even though the perceived problems were shared by stakeholders on an overall level, the findings indicate that the stakeholders did not have a completely shared understanding of the perceived problems, as they tended to focus on aspects most relevant to their own organization or perceptions. The challenge is to find which perceived problems are appropriate for inter-organization problem-solving and which can be solved within individual organizations.