Co-Occurring Disorders - Progress?
It's my great pleasure to introduce this issue of the National Council for Community Behavioral Healthcare's Journal of Behavioral Health Services & Research. And to offer comments in an area critical to readers of this journal and to member organizations as well as to the broader behavioral healthcare stakeholder community - co-occurring mental health and addictions disorders.
Addiction has come a long way from the days when it was perceived as a moral failure resulting from a lack of willpower. Today, there is growing public awareness and acceptance of addiction as a treatable disease; that addiction is a chronic, relapsing condition that requires continual monitoring and management, just as other chronic illnesses like diabetes, asthma, and hypertension and yes, like mental illnesses. And as the National Council more directly turns its policy attention and resources to advocacy for addiction prevention, treatment, and recovery, the question emerges--where on the advocacy and practice agenda is the treatment of co-occurring disorders?
Certainly the mental health and addiction fields have had a growing awareness of the prevalence and treatment challenges of co-occurring disorders and traditional services lack of success with this population. Yet, despite the evidence supporting the effectiveness of integrated treatment and pockets of innovative services, widespread access to integrated services remains elusive.
In 1997, the Center for Mental Health Services estimated that up to 10 million people meet the criteria for co-occurring disorders. The cost of not treating or ineffectively treating these individuals is untold in terms of human misery, lost productivity and costs to the taxpayer including the cost of incarceration. We can do better.
As a Senior Fellow of SAMHSA's Center for Co-occurring Excellence, I've watched lots of money go to vendors for technical assistance; seen lots of states awarded Co-occurring State Incentive Grants; and lived through many co-occurring policy academies. But little has trickled down to the front lines - to the 250,000 staff of our member organizations. There is little evidence that centrally administered grants for training, for planning initiatives, or for building stakeholder consensus can produce improvement in clinical practice.
And in fact there might be some obvious reasons for the failure of the trickle-down effect. The front lines are busy delivering services, they aren't attending conferences. And even if they have a chance to attend there is no evidence that the result is practice change. Conferences introduce new information, generate ideas and enthusiasm but practice change requires sustained organizational investment--leadership's commitment and vigilance, re-ordering priorities, operational re-alignments and ongoing outcomeoriented clinical supervision for staff.
We know there is a market for integrated mental health and addictions services and in response federal and state funding has been used to create a beehive of activity and noise led by an army of well-intentioned bureaucrats and consultants. No funding stream has been created for what is a new service line--providers are encouraged to create "braiding and blending" schemes that might or might not stand up to audit--nor have the organizations that are expected to deliver integrated treatment been offered financial support for the change process.
Organizations and practitioners can change but the change has to make clinical sense for the people they serve and there has to be the money to cover the costs of the change process. Adopting and delivering a new product or service line is expensive in any industry. It requires retooling operations, bringing on board enough experts to form a critical mass and retraining existing staff - all while continuing to do business. And for organizations with slim to non-existent profit margins, it's an impossible feat.
The National Council is prepared to join others that have worked over the last 15 years to accelerate the uptake of integrated treatment practices. What we bring to the table is a commitment to the available evidence about organizational and practice change coupled with knowledge of small business operations.
A first step in our advocacy is the recent introduction in the Senate of the Community Mental Health Services Improvement Act, S.2182. Included in S.2182 is a co-occurring mental illness and addictions treatment program.
We need to stop fooling ourselves and disappointing those who desperately need help--new treatments need new dollars.
Addiction has come a long way from the days when it was perceived as a moral failure resulting from a lack of willpower. Today, there is growing public awareness and acceptance of addiction as a treatable disease; that addiction is a chronic, relapsing condition that requires continual monitoring and management, just as other chronic illnesses like diabetes, asthma, and hypertension and yes, like mental illnesses. And as the National Council more directly turns its policy attention and resources to advocacy for addiction prevention, treatment, and recovery, the question emerges--where on the advocacy and practice agenda is the treatment of co-occurring disorders?
Certainly the mental health and addiction fields have had a growing awareness of the prevalence and treatment challenges of co-occurring disorders and traditional services lack of success with this population. Yet, despite the evidence supporting the effectiveness of integrated treatment and pockets of innovative services, widespread access to integrated services remains elusive.
In 1997, the Center for Mental Health Services estimated that up to 10 million people meet the criteria for co-occurring disorders. The cost of not treating or ineffectively treating these individuals is untold in terms of human misery, lost productivity and costs to the taxpayer including the cost of incarceration. We can do better.
As a Senior Fellow of SAMHSA's Center for Co-occurring Excellence, I've watched lots of money go to vendors for technical assistance; seen lots of states awarded Co-occurring State Incentive Grants; and lived through many co-occurring policy academies. But little has trickled down to the front lines - to the 250,000 staff of our member organizations. There is little evidence that centrally administered grants for training, for planning initiatives, or for building stakeholder consensus can produce improvement in clinical practice.
And in fact there might be some obvious reasons for the failure of the trickle-down effect. The front lines are busy delivering services, they aren't attending conferences. And even if they have a chance to attend there is no evidence that the result is practice change. Conferences introduce new information, generate ideas and enthusiasm but practice change requires sustained organizational investment--leadership's commitment and vigilance, re-ordering priorities, operational re-alignments and ongoing outcomeoriented clinical supervision for staff.
We know there is a market for integrated mental health and addictions services and in response federal and state funding has been used to create a beehive of activity and noise led by an army of well-intentioned bureaucrats and consultants. No funding stream has been created for what is a new service line--providers are encouraged to create "braiding and blending" schemes that might or might not stand up to audit--nor have the organizations that are expected to deliver integrated treatment been offered financial support for the change process.
Organizations and practitioners can change but the change has to make clinical sense for the people they serve and there has to be the money to cover the costs of the change process. Adopting and delivering a new product or service line is expensive in any industry. It requires retooling operations, bringing on board enough experts to form a critical mass and retraining existing staff - all while continuing to do business. And for organizations with slim to non-existent profit margins, it's an impossible feat.
The National Council is prepared to join others that have worked over the last 15 years to accelerate the uptake of integrated treatment practices. What we bring to the table is a commitment to the available evidence about organizational and practice change coupled with knowledge of small business operations.
A first step in our advocacy is the recent introduction in the Senate of the Community Mental Health Services Improvement Act, S.2182. Included in S.2182 is a co-occurring mental illness and addictions treatment program.
We need to stop fooling ourselves and disappointing those who desperately need help--new treatments need new dollars.
