Breaking New Ground: Integrated Treatment for CoOccurring Disorders

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Breaking New Ground Integrated Treatment for
Co-Occurring Disorders
A. KATHRYN POWER, DIRECTOR Center for Mental
Health Services Substance Abuse and Mental Health
Services Administration
October 31, 2005 Eau Claire, WI
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Co-Occurrence of Serious Psychological Distress
and Substance Use Disorders Among Adults Aged 18
or Older 2004
16.8 Million
15.2 Million
Serious psychological distress only
4.6 Million
Substance abuse disorder only
Co-Occurring Disorders
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Past-Year Treatment Among Adults Aged 18 or
Older with Co-Occurring Serious Psychological
Distress and a Substance Abuse Disorder 2004
Treatment for both mental health and substance
abuse disorders
Treatment only for mental health disorders
41.4
6.0
5.0
Treatment only for substance abuse
No treatment
47.5
4.6 Million Adults with Co-Occurring Mental and
Substance Abuse Disorders
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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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AP photo by Rod Hubar, Orlando Sentinel

• We will help the survivors regain their dignity
  in the face of their losses. We will give
  families some measure of privacy and access to
  public transportation and to the culture and
  services that our cities provide. Those who have
  lived through this ordeal deserve the chance to
  quickly return their lives to normal.

?Governor Jim Doyle
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SAMHSAs Ongoing Response to Hurricanes Katrina
and Rita

• Suicide crisis hotline
• SAMHSAs Emergency Response Center (SERC)
• Disaster Technical Assistance Center
• Emergency response grants
• Onsite support by deployed SAMHSA staff
  specialists
• Onsite assistance by SAMHSAs technical
  assistance centers on consumer/peer-run programs

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SAMHSAs Four Redwoods

• Address the needs of adults and youth with
  co-occurring mental and substance abuse
  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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Federal Partners Workgroup
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Federal Action Agenda First Steps

• 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, cross-walked with the six goals of the
  Commissions final report.
• Describes the "state of success" for each
  principle.
• Highlights current activities and proposes Year 1
  action steps for each principle.

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Photo by Jeff Lindsay, Appleton, WI
Two beautiful Hmong sisters from Menasha, WI, in
elaborate Hmong clothing. This photo was taken
shortly before a dance performance in Appleton,
WI.
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• We cannot for a moment believe that knowledge has
  reached its final goal or the present
  constitution of society is perfect. Whatever may
  be the limitations which trammel inquiry
  elsewhere, we believe the great State of
  Wisconsin should encourage that continual
  fearless sifting and winnowing by which alone
  truth can be found.

?A statement made by the regents of the
University of Wisconsin, as quoted by Zona Gale
in These United States (1924).
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What Challenges Lie Ahead?

• Financing

• Workforce development
• Measures of effectiveness and accountability

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Selected National Outcome Measures (NOMs)

• Decreased mental illness symptomatology/improved
  functioning1
• Increased/retained employment (adults) return
  to/retention in school (children)1
• Increased stability in family and living
  conditions
• 1Developmental

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What Challenges Lie Ahead (cont.)?

• Alignment of mental health and substance abuse
  approaches
• Leadership

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SAMHSAs Treatment Improvement Protocol (TIP) 42
Available free from SAMHSA at http//store.health
.org/catalog/
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Implementation Resource Kitswww.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 http//coce.samhsa.gov

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

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Wisconsin fertile ground for innovations in
behavioral health care. On, Wisconsin! Thank you.
Iowa County, WI. Photo courtesy of USDA Natural
Resources Conservation Service.