Integrated care for traumatic brain injury, mental health, and substance use: A systematic review

Objective(s): To summarize the current levels and types of integrated care for traumatic brain injury (TBI) and mental health and substance use (MHSU) and identify the reported barriers and facilitators to integrated care for TBI and MHSU.

Data Sources: Electronic databases were independently reviewed by two reviewers based on pre-determined eligibility criteria. The search was first conducted in September 2018 and updated in September 2020, with no changes to the search strategy. Where possible, searches were limited to English language and excluded animal studies, conference abstracts, magazines, books, and encyclopedias.

Study Selection: Peer-reviewed primary research articles and dissertations published on or after 2013 that met the following criteria were included: (1) Describe or evaluate a policy, program, or intervention or treatment at the health service delivery level for individuals with TBI and MHSU; (2) screen or diagnosis for TBI in a MHSU health service setting; or (3) screen or diagnosis for MHSU in a brain injury health service setting.

Data Extraction: A narrative synthesis was conducted using data extracted independently by one reviewer and peer-reviewed by a second reviewer. All articles were assessed for risk of bias independently by one reviewer using quality assessment tools and peer-reviewed by a second reviewer.

Data Synthesis: Fifty-nine articles were included, describing treatments (N=49), programs (N=4), or screening/diagnosis (N=7). These articles described clinical integrations at the micro- (N=38) and meso-levels (N=10), service integration at the micro- (N=6) and meso-levels (N=5), and functional integration at the meso-level (N=1). Seven articles reported on facilitators (e.g., cognitive accommodations in treatment plans) and two articles reported on barriers (e.g., lack of education on TBI and MHSU); six articles reported both barriers and facilitators.

Conclusions: Integrated TBI and MHSU care already exists across a range of levels and types. Given the finite and competing demands for healthcare resources, facilitators such as cognitive accommodations across treatment plans should be considered. Multidisciplinary teams should also be explored to provide opportunities for education among health professionals so they can be familiar with TBI and MHSU.

Author(s) Disclosures: None