title: Comorbidity Action in the North: a study of services for people with comorbid mental health and drug and alcohol disorders in the northern suburbs of Adelaide.
abstract: OBJECTIVE
  This study identified barriers to and facilitators of mental health (MH) and alcohol and drug (AOD) comorbidity services, in order to drive service improvement.
  
  
  METHODS
  Participatory action research enabled strong engagement with community services, including Aboriginal and refugee groups. Surveys, interviews and consultations were undertaken with clinicians and managers of MH, AOD and support services, consumers, families, community advocates and key service providers. Community participation occurred through consultation, advisory and working party meetings, focus groups and workshops.
  
  
  RESULTS
  Barriers included inadequate staff training and poor community and workforce knowledge about where to find help. Services for Aboriginal people, refugees, the elderly and youth were inadequate. Service fragmentation ('siloes') occurred through competitive short-term funding and frequent re-structuring. Reliance on the local hospital emergency department was concerning. Consumer trust, an important element in engagement, was often lacking.
  
  
  CONCLUSIONS
  Comorbidity should be core business of both MH and AOD services by providing consistent 'no wrong door' care. Non-governmental organisations (NGOs) need longer funding cycles to promote stability and retain skilled workers. Comorbidity workforce training for government and NGO staff is required. Culturally appropriate comorbidity services are urgently needed. Despite the barriers, collaboration between clinicians/workers was valued.
authors.affiliation: Consultant Psychiatrist, Northern Adelaide Local Health Network, Gilberton, SA, Australia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Liu
authors.affiliation: Adjunct Professor of Drug and Alcohol Nursing, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Charlotte
authors.initials: C
authors.lastname: de Crespigny
authors.affiliation: Professor of Mental Health Nursing, University of South Australia, Adelaide, SA, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Procter
authors.affiliation: Research Fellow, School of Nursing, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Kelly
authors.affiliation: PhD Candidate, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Hepsibah
authors.initials: H
authors.lastname: Francis
authors.affiliation: PhD Candidate, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Miriam
authors.initials: M
authors.lastname: Posselt
authors.affiliation: Research Coordinator, CAN Project, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Imelda
authors.initials: I
authors.lastname: Cairney
authors.affiliation: Professor of Psychiatry, The University of Adelaide; Ramsay Health Care (SA) Mental Health; Northern Adelaide Local Health Network, Gilberton, SA, Australia cherrie.galletly@adelaide.edu.au.
authors.forename: Cherrie
authors.initials: C
authors.lastname: Galletly
mesh_terms: D001315:Australia; D003156:Community Mental Health Services / Q000458:organization & administration*; D015897:Comorbidity; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D009938:Organizations / Q000191:economics; D012036:Refugees / Q000523:psychology; D019966:Substance-Related Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: aboriginal; community; culture; psychiatric; refugee; substance abuse