Clinical Scorecard: Structuring Housing and Service Delivery for Individuals with Concurrent Substance Use and Mental Health Disorders: A Scoping Review in the ROP Municipality

At a Glance

Key Highlights

• Persons with COP face complex challenges including increased risk of suicide, physical illness, social marginalization, and diagnostic overshadowing.
• Housing First (HF) model provides unconditional housing without requiring sobriety or treatment compliance, emphasizing harm reduction and client choice.
• Assertive Community Treatment (ACT) teams deliver intensive, multidisciplinary outreach to engage persons with severe mental illness and COP.

Guideline-Based Recommendations

Diagnosis

• Recognize the complexity and multimorbidity of COP beyond traditional dual diagnosis frameworks.
• Avoid diagnostic overshadowing by thoroughly assessing physical health symptoms in persons with COP.

Management

• Implement harm reduction strategies alongside trauma-informed, culturally sensitive, and recovery-oriented care.
• Use Housing First model to provide secure, unconditional housing as a human right.
• Employ Assertive Community Treatment teams for active outreach and continuous multidisciplinary support.

Monitoring & Follow-up

• Continuously assess housing stability and engagement with services.
• Monitor for risks of relapse, suicide, and physical health deterioration.
• Evaluate client choice and empowerment within treatment and housing programs.

Risks

• Risk of social marginalization and systemic discrimination including stigma and racism.
• Potential for treatment non-disclosure due to fear of losing housing or support.
• Misapplication of abstinence-based requirements undermining harm reduction and housing rights.

Patient & Prescribing Data

Individuals with co-occurring substance use and severe mental illness, often with histories of trauma, poverty, and social isolation.

Engagement improves with person-centered, flexible approaches that respect client autonomy and integrate housing with treatment without preconditions.

Clinical Best Practices

• Adopt whole-person, compassionate care approaches emphasizing resilience and individual resources.
• Prioritize secure housing as a fundamental human right independent of behavioral change.
• Integrate harm reduction with motivational interviewing and trauma-informed care.
• Facilitate collaboration, empowerment, and peer support within culturally and gender-sensitive frameworks.
• Avoid conditional housing requirements that conflict with harm reduction principles.

References

• United Nations Sustainable Development Goals
• Housing First Model Overview
• Assertive Community Treatment (ACT) Model
• UN Universal Declaration of Human Rights (1948)