How well do international clinical guidelines on mental health and substance misuse address their coexistence? a systematic review of scope, quality and inclusivity

Abstract

Abstract Objective: The most prevalent problem among severe mental illness (SMI) patients is substance use disorder (SUD). This systematic review aims to assess whether international guidelines have addressed any recommendations in relation to diagnosing and managing both SMI and SUD affected patients and also tries to identify how inclusive are international guidelines on severe mental health problems or substance misuse in relation to social issues including the risk of homelessness and being subjected to the criminal justice system for those patients affected by SMI? Method: The study protocol provisionally registered in PROSPERO. The research for guidelines is conducted using the following databases: MEDLINE, Cochrane Library, EMBASE, PsychInfo, Google, Google scholar. This search was conducted in May 2020. The assessment of guidelines quality based on Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Result: In total, 12,644 records were identified. Of these, 21 guidelines are included in this review, three guidelines were related to coexisting disorders, eleven guidelines were related to SMI, and seven guidelines were related to SUD. While the guidelines related to coexisting disorders considered diagnosis and treatment for co-existing disorders, seven of the single disorder guidelines did not adequately take into consideration the importance of diagnosis or treatment of concurrent problems and minimizing fragmentation of care. Fifteen guidelines did not address treatment adjustments in accordance with the other disorder. Assessment of guidelines quality based on AGREE II statements showed that the included guidelines rated from a high to moderate quality. Conclusion: Guidelines for management of either SUD or SMI tend to have limited considerations of coexisting disorders. There is a need for the guidelines to be more inclusive in order to enable better diagnosis and treatment as well as to cover social consequences of concurrent disorders.