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Building Bridges:
Co-Occurring Mental Illness and Addiction: Consumers and Service Providers,
Policymakers, and Researchers in Dialogue
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Introduction
The growing number of persons with co-occurring mental and substance
use disorders in the United States has precipitated a crisis. In 2002, Charles
G. Curie, Administrator of the Substance Abuse and Mental Health Services Administration
(SAMHSA) within the U.S. Department of Health and Human Services (DHHS), announced
that addressing the needs of persons with co-occurring disorders had become
one of the highest priorities for the agency. The problems have not been easy
to solve, however. The crisis has been exacerbated by previously established
separate systems of care for mental health and addictions.
The two systems of care have different approaches to (1) identifying key symptoms,
(2) making assessments or diagnoses, (3) deciding between quite disparate treatment
approaches, and (4) figuring out which State block grant funding category should
be used to obtain coverage and reimbursement for services. The systems, at
Federal, State, and local levels, challenge consumers and service providers
alike, and, in some cases, create divisions between providers and consumers,
and between the providers themselves.
In addition to SAMHSA, many other agencies also are working on this issue.
The Centers for Medicare and Medicaid Services (CMS) have pilot projects that
demonstrate simpler ways of administering services for co-occurring disorders.
Several States have found ways to integrate substance abuse and mental health
funding, to improve access to services by mandating nondiscrimination of persons
with co-occurring disorders, and to certify consumers to assist in service
delivery. The National Association of State Alcohol and Drug Abuse Directors
(NASADAD) and the National Association of State Mental Health Program Directors
(NASMHPD) have jointly developed a conceptual framework for identifying and
addressing the needs of persons with co-occurring disorders.
On December 2, 2002, U.S. Department of Health and Human Services Secretary
Tommy G. Thompson sent Congress a comprehensive report on treatment and prevention
of co-occurring substance use and mental disorders. This congressionally mandated
report, developed by SAMHSA, emphasizes that people with co-occurring disorders
can and do recover with appropriate treatment and support services. It identifies
many longstanding systemic barriers to such treatment and services, and the
need for various Federal agencies, State agencies, providers of services, researchers,
recovering persons, families, and others to work together to create a system
that addresses both disorders as primary conditions. It also outlines a 5-year
blueprint for action to improve the opportunity for recovery by increasing
the availability of quality prevention, diagnosis, and treatment services for
people with co-occurring disorders.
In addition, SAMHSA awards large State infrastructure grants to address co-occurring
disorders and awards multiple grants that focus on various target populations
with co-occurring mental and substance use disorders.
SAMHSA is promoting other efforts to help individuals with co-occurring disorders.
In fall 2003, SAMHSA created the National Co-Occurring Disorders Prevention
and Treatment Cross-Training Center (COCE) to foster improvement in treatment
and services to individuals with co-occurring mental and substance abuse disorders.
In April 2004, SAMHSA sponsored the first National Policy Academy on Co-Occurring
Mental and Substance Abuse Disorders in Baltimore, Maryland. Ten State teams
and more than 150 individuals participated. The policy academy was designed
to assist States and local policymakers in developing an action plan to improve
access to appropriate services for people with co-occurring substance abuse
and mental disorders. SAMHSA anticipates conducting two additional policy academies
in FY 2005.
SAMHSA has extensive resource information on co-occurring disorders on its
Web site, including reports, publications, and documents, and maintains an
electronic discussion list. Finally, SAMHSA is providing technical assistance
on this issue through the convening of national conferences and other activities.
The Center for Mental Health Services (CMHS), within SAMHSA, has been given
the lead in implementing the policies to improve the coordination of treatment
and services identified by President George Bush’s New Freedom Commission on
Mental Health. The Commission’s Final Report highlights the importance of convening
participatory dialogues—a process that CMHS has used since 1997 to bring together
consumers of mental health services and professional service providers. In
2003, the crisis level of co-occurring disorders made it clear that CMHS should
convene a dialogue between consumers with co-occurring mental health and substance
use concerns and service providers, policymakers, and researchers. This report
summarizes the meeting and the recommendations made by the participants.
Meeting Participants and Process
Twenty-three people gathered in May 2003 for the dialogue. Paolo del Vecchio
and Chris Marshall of the SAMHSA Center for Mental Health Services welcomed
the group and emphasized the importance that SAMHSA places on promoting interaction
and dialogue between consumers and other stakeholders in mental health and
substance use policies and programs.
The process of the dialogue, designed by a planning committee of several participants
and CMHS staff, and the meeting objectives were straightforward and supportive
of participants. After the participants introduced themselves, the discussion
focused on three topics:
- Person-centered factors that hinder or promote recovery. These included personal
experiences, values, and beliefs; consumer and provider expectations; and concerns
related to age, ethnicity, and culture.
- System-level factors that hinder or promote recovery. These included administrative
structures and services coordination; research knowledge about models
and best practices; funding and regulatory issues; and core competencies
and
training.
- Recommendations for improved understanding and service delivery. These
covered nine different areas and focused on themes such as consumer-driven
policymaking,
research, and services delivery; the whole-person focus; public awareness
and education; and coalition building.
The dialogue was conducted as a roundtable discussion. At the close of
each discussion topic, participants offered summary comments to help
pull together
the group’s thinking to that point.
DHHS Publication No. (SMA) 04-3892
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