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The mental health and substance abuse fields

The mental health and substance abuse fields have had a growing awareness of the prevalence of co-occurring disorders and the challenges presented by this population. The lack of success within traditional treatment settings for individuals with co-occurring disorders is well documented. Estimates suggest that while about 20 percent of the U. S. population is affected by mental disorders in any given year, only one-third of people in need of mental health treatment receive it.

When it comes to substance abuse disorders, between 13 million and 16 million people need treatment for lcoholism and/or drug abuse in any given year, but only 3 million (20 percent) receive care. 10 millions Americans met the criteria for co- concurring disorders in any given year, but only half of the substance abuse treatment facilities provided programs for dually diagnosed clients. Out of all the State/local government operated facilities only 11 percent provided services; (SAMHSA, 2003) and exclusions within these programs deny services to individuals with certain diagnoses such as schizophrenia, and Bi-polar disorders.

There is a need to incorporate the treatment of dual iagnosed clients to this program. The continuum of services would increase by providing a comprehensive, integrating mental health and addiction treatment into the program design. Slide 2 [pic] Every individual regardless of the severity and disability associated with his or her co-occurring disorders is entitled to experience the promise and hope of recovery.

Slide 3 [pic] Admissions reports indicate that services are denied to a significant number of clients that apply for services due to a mental illness. Clients are being admitted and then mental health issues are revealed, resulting in lient being discharged from the program, or the problem is not being addressed during the treatment stay. Presently if an individuals during treatment is found to have a mental health issue and in need of psychotropic medication they usually result in discharge from the program.

Even though the program attempts to exclude individuals with co-occurring disorders, there are successful graduates with co-occurring disorders who were not detected at the time of admission. In determining which individuals are eligible for services the attempt to screen out individuals ith co-occurring mental disorders is done during the admission process. Given the high frequency of co-occurring disorders in the United States, this approach excludes a large number of potential admissions.

The current program design deprives those with the greatest needs from receiving effective services. Slide 4 [pic] Data was gathered through literary surveys, observation, data bases, websites, agency records, client survey data, and existing statistics from state treatment agencies. Research was expedited by building on previous research. Using the dependent variable access to services needed, and the Independent variables: Substance abuse and mental disorders, dual diagnosed clients: The intervening variable was integration of substance abuse and mental health treatment services.

Slide 5 [pic] Despite increasing evidence that outcomes for persons with co-occurring mental and substance use disorders improve when care is provided in a comprehensive and integrated fashion. Providers in both systems still tailor their approaches to treatment according to individual categories of disorders with segregated admissions criteria, treatment programs, services and reimbursement: (Drake et al. 2001) Resulting in consumers bouncing back and forth between the mental health and substance abuse service systems. When substance abuse disorders and mental disorders occur at the same time in an individual, they lead to significant loss of human potential and increased costs for service systems – losses and costs greater than those arising from each of the disorders alone.

Moreover, a growing body of evidence suggests that integrated rather than parallel and sequential treatment approaches are especially effective for people with more severe functional impairment due to co-occurring substance abuse isorders and mental disorders. (SAMHSA-2002) Historically mental health and substance abuse treatment approaches have been somewhat different, principles of care within the two fields converge on respect for the individual, reaching out to engage those who cannot yet trust, and the importance of community, family, and peers to the recovery process (Osher, 1996) The concept of “recovery” is now increasingly the focus of treatment in both systems.

Many researchers and clinicians believe that “both disorders must be considered as primary and treated as such” (Ridgely, Osher & Talbott, 1987; Minkoff, 1991; Drake, McLaughlin et al. , 1991; Osher and Kofoed, 1989). Slide 6 [pic] There is a need to bridge the gap, and create an effective system of care for persons with co-occurring disorders. Access to services remains elusive to most individuals with this condition.

Research indicates that mental health and substance abuse providers alike encounter difficulties in accessing comprehensive services for dually-diagnosed clients. (Ridgely,Osher,& Talbot,1987). Without treatment, individuals continue to have a suboptimal standard of living, including homelessness, and nstitutionalization. For the past 15 years, extensive efforts have been made to develop integrated models of care that bring together mental health and substance abuse treatment.

Recent evidence from more than a dozen studies shows that comprehensive integrated efforts help persons with co- occurring disorders reduce substance use and attain remission (Drake et al. , 1998). Positive outcomes associated with integrated approaches include a reduction in hospital utilization, psychiatric symptomatology, substance use, and other problematic negative outcomes. Substance abuse among ersons with mental illness has been associated with negative outcomes including increased vulnerability to relapse and rehospitalization.

Even small to moderate levels of alcohol and drug use can produce significant difficulties, including enhanced stress, return of major mental health symptoms, loss of housing and social supports, and unemployment for individuals with a mental illness. (Caton et. al, 1993; Haywood et al. , 1995; Seibel et al. , 1993). Research indicates that individuals of all ages who have co-occurring disorders have multiple, interactive conditions that omplicate their treatment and, when left untreated, produce negative outcomes.

The problem of co-occurring substance abuse disorders and mental disorders can no longer be ignored. The results from a study integrating data from State mental health, substance abuse, and Medicaid agencies found that individuals with a single diagnosis (substance abuse or mental disorder) were not likely to be hospitalized. In 1996 there were 87 hospital stays per 1,000 for individuals with a mental disorder only and 23 stays per 1,000 for individuals with substance abuse only in 1996.

In ontrast, individuals with co-occurring substance abuse disorders and mental disorders were considerably more likely to be hospitalized, at a rate of 457 hospitalizations per 1,000 (SAMHSA, 2001a). Individuals with co- occurring disorders are not the exception in substance abuse and mental health treatment systems. “It is expected that an individual with a mental disorder is at increased risk for developing a substance abuse disorder and, conversely, that a person with a substance abuse disorder is at increased risk for developing a mental disorder. ” (Drake et al. , 1998).

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