Decentralisation and integration of addiction treatment - Does it make any difference?

The treatment of addiction problems in Sweden is handled at the county level within both the mental health care system and the municipal social service system, with approximately half of the patients/clients on any given day in each system. In the mid-1990s a reform of the addiction treatment system in Stockholm county (approx. 2 million inhabitants) was implemented by municipal and county politicians. The rationale was to shift the emphasis to local outpatient units within the health care system that would work in close cooperation with the social services. The county's addiction treatment was divided into two parts: the North and the South. The reform was well received in the North and seemed to be fairly quickly implemented. In the South, however, the resistance was open and changes slow. In the years 2000-2004 a large one-year follow-up study of 1,800 patients/clients in both parts of the treatment system was conducted. By comparing the clients/patients from the North and the South, we were able to evaluate the effects of decentralisation and the shift from inpatient to outpatient treatment. This presentation will address the question: Does a decentralised and integrated system make any differences in terms of who gets into the treatment system what happens after treatment?