How to Improve Quality of Life Among ‘Hard-to-Reach’ Persons with Substance Use Problems: In Search of Inspiring Practices

From the 1980s onwards, persons with co-occurring substance use and mental health problems came into the picture of mental health care. The everyday realities of this heterogeneous population are more complex than their twofold label suggests, as they are often also confronted with homelessness, a poor physical health, judicial problems, financial problems, social isolation and exclusion, stigma and discrimination, among other difficulties. To meet these complex needs, both mental health care and specialized addiction treatment services have gradually adopted the concept of recovery as guiding principle. Despite these developments, persons with co-occurring substance use and mental health problems still run a high risk of falling between the cracks of existing services and are often described as a ‘hard-to-reach’ population. However, treatment modalities are often insufficiently attuned to service users’ needs and lifeworld, resulting in a high dropout, a pessimistic prognosis and poor quality of life outcomes. To fill this void, in recent years, a growing number of innovative practices have been founded that actively aim to promote the quality of life of this group, by applying an alternative treatment approach. We will provide insight into two inspiring practices in Belgium that specifically engage with persons with co-occurring disorders: a street nurse project and a low-threshold meeting place. By reflecting upon and drawing parallels between these places, the aim of this chapter is to outline a number of indispensable contours for promoting quality of life and supporting recovery processes in persons with co-occurring substance use and mental health problems.