Barriers to psychiatric treatment for the comorbid mental health problems of marginalized people who use drugs: perceptions of frontline staff in low-threshold facilities

Purpose: This paper aims to research the barriers that staff in low-threshold facilities experience when they try to facilitate contact with the psychiatric treatment system on behalf of people who are marginalized and use drugs (PMUD) and suffer comorbid mental health problems. 

Design/methodology/approach: This is a qualitative, phenomenologically inspired study based on in-depth interviews with 15 frontline staff members working at different low-threshold facilities in the open drug scene in Copenhagen. Analysis is inspired by systematic text condensation, and this paper used an analytical framework that divides barriers into those generated by personal characteristics and structural barriers. 

Findings: Staff experience both types of barriers when they try to facilitate contact with the psychiatric treatment system on behalf of PMUD. Personal characteristic barriers include client worries about having to make it without drugs if admitted to a psychiatric ward and about being subject to coercion, experiencing discrimination by staff and paranoia about the system. Structural barriers include a psychiatric treatment system that lacks commitment and flexibility, with a focus on acute conditions. 

Originality/value: This study provides in-depth knowledge about the specific barriers in the psychiatric treatment system that need to be changed to ensure proper treatment for PMUD with comorbid mental health problems.