Referring agents’ perceptions of access barriers to inpatient substance abuse treatment centres in the Western Cape

Abstract

High rates of substance use and its associated problems afflict Cape Town, underscoring the need for easily accessible substance abuse treatment. Despite the substantial benefits for both individuals and society at large that substance abuse treatment confers, substance abusers often first have to negotiate considerable challenges in order to access treatment and accumulate these gains. That is, experiencing barriers to accessing treatment, together with the presence of socio-demographic features, rather than “need for treatment”, decides who accesses treatment. Referrals are the gateway to inpatient substance abuse treatment in the Western Cape. While several barriers to accessing treatment have been identified by prior studies, none examine these phenomena from the point of view of the agents responsible for referring substance users for treatment. Moreover, access barriers to inpatient substance abuse services are a neglected area in extant literature. To address this gap, this study explored the perceptions of referring agents‟ of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape. This enabled the researcher to compare existing access barriers to treatment as identified by prior research, to those elucidated in the study. Bronfenbrenner‟s Process-Person-Context-Time model was employed as the basis for understanding identified barriers. In accordance with the exploratory qualitative methodological framework of the study, six semi-structured individual in-depth interviews were conducted with referring agents‟ of differing professional titles who were purposefully selected and expressed a willingness to participate in the study. Interviews were audio-recorded, and transcripts were analysed and interpreted by means of Thematic Analysis. Two broad thematic categories of access barriers were identified: Person-related barriers (denial, motivation for treatment, gender considerations, disability, active TB disease, homelessness, psychiatric co-morbidity) and Context-related barriers to treatment (cultural and linguistic barriers, stigma, community beliefs about addiction and treatment, awareness of substance abuse treatment, affordability/ financial barriers, geographic locations of treatment facilities, waiting time, lack of collaboration within the treatment system, beliefs of service providers‟, lack of facilities/ resources within the treatment system, practices at inpatient facilities, referral protocol and uninformed staff). Results suggest that by targeting the aforementioned barriers, access to inpatient and outpatient treatment services can be improved, and recommendations for interventions are offered in this regard. Ethical principles such as obtaining informed consent and ensuring confidentiality were abided by throughout the study and thereafter.