Institutional analysis of integrated treatment for co-occurring mental health, substance use and gambling problems in Ontario: A case study

This dissertation explores the institutionalized response of the mental health and addiction sectors in Ontario to the pervasive demand for integrated services for people with concurrent disorders. Building on neo-institutional theory, I argue that despite the fact that different stakeholders on multiple levels - provincial governments, service providers, and clients - have called for the integration of treatment for concurrent disorders, this integrated treatment is implemented as a rationalized myth and adopted only ceremonially.;My findings address both macro- and micro-level foundations of the institutionalization of integrated practices. I have identified four key factors in the process of establishing integrated treatment for concurrent disorders as a standard practice. First, changes in public perceptions of mental health, substance use and gambling problems are associated with subsequent shifts in federal and provincial policies and mandates. Second, the need to conform to the public's expectation for more cost-effective services has brought challenges in providing comprehensive client-centered care. These challenges are exacerbated by the increased reliance on technically-driven cost efficiency when planning treatment outcomes. Third, on the micro level, the endorsement of evidence-based practices is mutually related to internal structuring and specialization of care. Lastly, the institutionalization of integrated treatment is associated with individual involvement by social actors and their pursuit of personal and professional interests.;This is demonstrated through a case study of two treatment programs that provide services to populations with concurrent mental health and substance use problems and gambling problems. Both programs are organized as part of the Centre for Addiction and Mental Health in Toronto.