Samordning av lokalbaserte tjenester: Når svake formelle samordningsstrukturer kompenseres av uformelle samordningsgrep

Abstract

By studying how primary care providers organize their services for people with concurrent substance abuse and mental health problems (dual diagnosis), this study aims to investigate formal and informal integration mechanisms. The study has an explorative approach based on interviews with people with dual diagnosis, managers, and front-line professionals in a Norwegian municipality of medium size. We found poor formal structures for internal coordination between services for mental health care and services for substance abuse, although they were organised in the same unit. Further, there were challenges in cooperation between this unit and the other healthcare units. Front-line professionals seemed to compensate for poor formal organisational structures with individual, informal coordination arrangements. Drawing on organisational theory, in particular the dilemmas of street-level bureaucrats and the role they play in policy implementation, this chapter discusses the importance and limitations of informal coordination measures for people with dual diagnosis.