Cooccurring Disorders: Navigating the Road Ahead

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Co-occurring Disorders Navigating the Road Ahead

• FRAN RANDOLPH, Dr.P.H.
• Director, Division of Services and Systems
  Improvement
• Center for Mental Health Services
• Substance Abuse and Mental Health Services
  Administration

July 26, 2005Austin, TX
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Integrated Treatment

• refers to any mechanism by which treatment
  interventions for both disorders are combined
  within the context of a primary treatment
  relationship or service setting.

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How Serious Is the Problem?
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Co-Occurrence of Serious Mental Illnesses and
Substance Use Disorders Among Adults Aged 18 or
Older 2003
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Past Year Treatment Among Adults Aged 18 or
Older with Co-Occurring Serious Mental Illnesses
anda Substance Use Disorder 2003
Treatment for Both Mental Health and Substance
Abuse Problems
Treatment Only for Mental Health Problems
39.8
7.5
3.7
Substance Abuse Treatment Only
No Treatment
49.0
4.2 Million Adults with Co-Occurring SMI and
Substance Abuse Disorder
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What Is SAMHSAs Response to Co-occurring
Disorders?
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SAMHSAs Four Redwoods

• Address the needs of adults and youth with
  co-occurring mental and substance use disorders
• Build substance abuse treatment capacity
• Implement the Strategic Prevention Framework
• Transform the mental health system

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U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services
Administration (SAMHSA)
Center for Mental Health Services (CMHS)
Center for Substance Abuse Prevention (CSAP)
Center for Substance Abuse Treatment (CSAT)
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Achieving the Promise Transforming Mental Health
Care in America
The time has long passed for yet another
piecemeal approach to mental health reform.
Instead, the Commission recommends a fundamental
transformation of the Nations approach to mental
health care.
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In a Transformed Mental Health System?

• Goal 1. Americans understand that mental health
  is essential to overall health
• Goal 2. Mental health care is consumer and family
  driven
• Goal 3. Disparities in mental health services are
  eliminated
• Goal 4. Early mental health screening,
  assessment, and referral to services are common
  practice
• Goal 5. Excellent mental health care is delivered
  and research is accelerated
• Goal 6. Technology is used to access mental
  health care and information

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Transformation Values

• Consumer and family driveneach adult and child
  will have access to the full spectrum of services
  needed to support recovery.
• Recoverya process, sometimes lifelong, through
  which a consumer achieves independence,
  self-esteem, and a meaningful life in the
  community.
• Resiliencethe ability to face lifes challenges.

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Federal Partners Workgroup
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Federal Action Agenda First Steps(available
online at www.samhsa.gov)

• Provides a model for shared responsibility at
  State and local levels
• Features the five principles around which the New
  Freedom Commission on Mental Health framed its
  work and its vision
• Describes the "state of success" for each
  principle
• Highlights current activities and proposes Year 1
  action steps for each principle

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Where Is Texas on the Road to Integrated
Treatment?
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Markers Along the Road to Integrated Treatment

• Build consensus around the need for an integrated
  response
• Develop aggregated financing mechanisms
• Cross-train mental health and substance abuse
  professionals
• Measure improvements in terms of client
  functioning and quality of life

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Department of Health
Texas Commission on Alcohol and Drug Abuse
Department of Mental Health
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• Actions deferred are all too often opportunities
  lost.

John F. Kennedy
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What Challenges Lie Ahead?
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Roadblocks To Integrated Care

• Cultural competency and literacy
• Financing structures
• Credentialing and licensing
• Workforce development
• Alignment of mental health and substance abuse
  approaches

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What Direction Does SAMHSA Provide?
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People With Co-occurring Disorders May Enter
Treatment Through One of Four Doorways
Substance Abuse Mental Illness
Physical Illness Jail
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Partners for Recovery

• People in recovery
• Primary healthcare
• Child welfare
• Criminal juvenile justice system
• Housing
• Education
• Business
• Labor
• Community faith-based organizations

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SAMHSAs TIP 42
Available free
from SAMHSA at
http//store.health.org/catalog/
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Implementation Resource Kits www.mentalhealth.samh
sa.gov

• Co-occurring Disorders Integrated Dual Disorders
  Treatment
• Illness Management Recovery
• Medication Management Approaches in Psychiatry
• Assertive Community Treatment
• Family Psychoeducation
• Supported Employment

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National Registry of Effective Programs and
Practices (NREPP)
http//modelprograms.samhsa.gov
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Co-Occurring Center for Excellence
http//coce.samhsa.gov/
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Services Offered

• Overview papers, technical reports, and other
  information resources
• Technical assistance
• Cross-training
• Meetings and conferences
• Pilot evaluation of the Performance Partnership
  Grant (PPG) measure

Co-Occurring Center for Excellence http//coce.sa
mhsa.gov/cod_resources/papers.htm
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Overview Papers Available from COCE
Definitions and Terms Relating to Co-Occurring
Disorders Screening, Assessment, and Treatment
Planning for Persons With Co-Occurring Disorders
Overarching Principles To Address the Needs of
Persons With Co-Occurring Disorders
Co-Occurring Center for Excellence http//coce.sa
mhsa.gov/cod_resources/papers.htm
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Almost every Texas child has been told by a
father or by a smart uncle never to pick fights
or to go out of the way to seek trouble of any
kind, but, when once involved in a fracas, to do
his or her darndest, no matter what the odds.
Stanley Walker Texas