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Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Talking Points
SAMHSA’s Release of the New Co-Occurring Disorders Treatment Improvement Protocol
Washington, DC
January 31, 2005
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
First of all, I commend Westley Clark and the Center for Substance Abuse Treatment (CSAT) for the development and publication of Treatment Improvement Protocol (TIP) 42: Substance Abuse Treatment for Persons With Co-occurring Disorders. This TIP reflects a growing challenge to behavioral health care: people with co-occurring disorders should be the expectation—and not the exception—of those seeking treatment for mental or substance use disorders. This TIP responds to that challenge with a proven solution: integrated care. Integrated care offers the greatest hope in recovery to the millions of Americans with co-occurring disorders because it coordinates substance abuse and mental health interventions to treat the whole person more effectively. Our minds and our bodies are inseparable: we cannot treat one effectively without also treating the other.
CSAT deserves special recognition for bringing together a broad-based coalition of stakeholders to help prepare this TIP. These stakeholders included primary health care, criminal justice, and child welfare as well as mental health professionals. This coalition underscores what we know about the social consequences of co-occurring disorders: every system that serves adults and children has a stake in better treatment and prevention of these disorders.
I emphasize “prevention” for a very specific reason. The number of persons who already have co-occurring disorders pales beside the number of persons who are at risk of developing both disorders. About 20 million American adults have a serious mental illness, such as chronic depression or bipolar disorder. These individuals are more than twice as likely to use illegal drugs as those without a mental illness. In fact, research suggests that up to half of persons with a serious mental illness will develop a substance use disorder at some point in their lives. Clearly, we need to develop more effective methods to prevent co-occurring disorders and to diagnose and treat them as early as possible. The future health and well being of persons with mental illnesses as well as the health and well being of our communities depend on it. This TIP recognizes the significant relationship between mental and substance use disorders. Consequently, it is a giant step forward toward more informed treatment of persons who have or are at risk of developing co-occurring disorders.
As Administrator Curie pointed out, this TIP fits within a larger framework of actions being taken by the Substance Abuse and Mental Health Services Administration (SAMHSA) to ensure that all Americans can lead a full life within their communities. Finding better ways to address co-occurring disorders, together with mental health transformation, are two of SAMHSA’s four redwood, or top priority, programs.
Mental health transformation refers to a national movement spearheaded by SAMHSA, through the Center for Mental Health Services, to transform our current national mental health system. We have joined together with 20 other Federal agencies to determine how we can create a system that is truly consumer driven and focused on recovery. Our roadmap for change is the report released by President Bush’s New Freedom Commission on Mental Health, which is called Achieving the Promise: Transforming Mental Health Care in America. This commission found that our current mental health system is so fragmented and inadequate that only a complete transformation will fix it.
This TIP embodies the concept of transformation because it represents a change from our traditional, divided way of treating co-occurring disorders. In addition, this TIP represents progress toward many of the goals and recommendations of a transformed system. These include:
- Screening and assessment tools to diagnose illnesses as early as possible. This TIP includes assessment tools for people who have specific mental illnesses. This is a major step toward greater understanding of how the special characteristics of an illness can complicate diagnosis, treatment, and recovery. A more individualized approach will improve a person’s hope for recovery in two ways: more accurate diagnosis and more appropriate treatment, with both tailored to the unique strengths and vulnerabilities of each person.
- Evidence-based practices so that individuals receive the best treatment available. Administrator Curie mentioned our best practices kit for co-occurring disorders. This kit looks at co-occurring disorders from the community mental health agency perspective. We developed this kit to enhance a counselor’s knowledge in providing an integrated, evidenced-based approach to treating co-occurring disorders. However, we also designed the kit to promote systemwide change within an agency. It is not enough to change only the counselor’s approach—we also need to engage consumers, their families, and administrators in supporting a new approach to recovery.
SAMHSA is doing more than making this kit widely available online. We also are pilot testing this kit in five States to assess its use with different populations and in different settings. Evaluations by community-based organizations across the five States will tell us how we can improve this kit to increase its effectiveness for individuals of any age, race, or gender who need integrated care. Eliminating disparities of care among different populations is another goal of a transformed system.
CMHS will use our integrated dual diagnosis kit to increase stakeholder awareness of our new co-occurring disorder TIP. Whenever any State or provider requests a kit, we will include the TIP as a companion piece. More widespread use of this TIP and its wealth of information is essential to ensuring that “any door” becomes the “right door” for people seeking treatment for mental illnesses, substance use disorders, or both.
- Health technology to improve care. By publishing this TIP online, SAMHSA has made it available to every provider and consumer with Internet access. In addition, we will be able to easily update the information it contains so the TIP will remain state-of-the-science. Science and research continuously identify exciting new possibilities for treating addictions and mental illnesses. Our use of health technology offers unprecedented opportunities for us to share emerging knowledge that can facilitate recovery.
- Most important, the TIP makes care more consumer-driven and focused on recovery—the very foundation of transformed mental health care. During its development, CSAT drew heavily on the knowledge of those with hands-on experience, including consumers. There is no one better to determine how care can be consumer driven than consumers themselves. Based on their own lived experiences, they have helped us to identify the kinds of treatments and supports that are needed and effective in promoting and sustaining recovery.
Too many Americans fail to realize that mental illnesses—similar to substance use disorders—are treatable and that recovery is possible. Perhaps the most valuable message of the co-occurring disorder TIP is this: people can recover, people do recover. This TIP is our opportunity to spread that message nationwide.
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