Addressing treatment capacity of uninsured adults with co-occurring disorders

2020 ◽  
Vol 13 (3) ◽  
pp. 111-121
Author(s):  
Kenneth J. Gruber ◽  
Kelly Jay Poole ◽  
Kelly N. Graves ◽  
Antonia Monk Richburg
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Mental Health Treatment ◽  
Patient Treatment ◽  
Substance Use Treatment ◽  
Small Scale ◽  
Clinical Practices ◽  
Content Type ◽  
Treatment Services ◽  
Uninsured Adults

Purpose The purpose of this paper is to report on the success of an initiative involving the transformation of a group of small substance use treatment only or mental health treatment only provider agencies serving uninsured adults into providers of co-occurring disorder treatment. Design/methodology/approach The paper uses a case study narrative to describe the initiative and the transformation of the participant agencies from being providers of mental health or substance use treatment to providers of co-occurring disorders. Findings Six agencies serving uninsured adults expanded their scope of patient treatment services to include the capacity to treat adults with co-occurring disorders. This was achieved with modest support funding from a local foundation. The initiative has been ongoing for five years. Practical implications The outcome of this initiative demonstrates the financial and practical feasibility of improving and expanding treatment services to low-resourced patient populations. The participating agencies were able to improve their capacity to treat patients with substance use or mental health issues that previously they were not prepared to treat and thus increased their ability to provide integrated care. Originality/value The initiative described here shows that the treatment of concomitant substance use and mental health disorders is within the range of many small-scale treatment providers, if provided the leadership and support. Delivery of effective treatments to populations experiencing co-occurring disorders that are underserved and undertreated are achievable in community-based clinical practices. This has implications for developing treatment capacity outside of hospital settings to enable treatment of co-occurring disorders to become more accessible.

Expanding the use of the ASAM CriteriaTM to make mental health level of care placements

2018 ◽  
Vol 11 (2) ◽  
pp. 49-59
Author(s):  
Walter Matthew Drymalski
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Behavioral Health ◽  
Mental Health Treatment ◽  
Independent Living ◽  
Psychotic Symptoms ◽  
Health Issues ◽  
Addiction Medicine ◽  
Content Type ◽  
Living Skills

Purpose Despite the prevalence of co-occurring mental health and substance use disorders, the assessment and placement processes for each often remain separate. The purpose of this paper is to describe an expanded use of the American Society of Addiction Medicine (ASAM) CriteriaTM to make placements into substance use, co-occurring, and mental health treatment. Design/methodology/approach A rationale for the development of two new domains (Domain 7, substance use and Domain 8, independent living skills) and preliminary data supporting the use of the ASAM CriteriaTM as a placement process for all types of behavioral health issues will be provided. Findings Dimension 3 and Domains 7 and 8 were correlated with selected clinical indices in the expected direction (Dimension 3: depression (F (4, 4650)=202.092, p<0.001), medication usage (F (4, 4,637)=174.254, p<0.001), and psychotic symptoms (F (4, 4,561)=62.954, p<0.001); Domain 7: alcohol use (F (4, 4,458)=213.786, p<0.001) and drug use (F (4, 4,471)=611.491, p<0.001); and Domain 8: functional impairment (F (4, 3,927)=815.646, p<0.001) and number of “high needs” (F (4, 3,927)=737.568, p<0.001). Research limitations/implications The limitations of this research included a lack of inter-rater reliability data and less established intake assessments. Practical implications This single placement approach for clients seeking behavioral health services can create a more efficient, person-centered intake experience. Originality/value This paper suggests that it is possible to deploy a single assessment and placement approach for all types of behavioral health issues.

Facilitators and barriers in dual recovery: a literature review of first-person perspectives

2014 ◽  
Vol 7 (3) ◽  
pp. 107-117 ◽  
Author(s):  
Ottar Ness ◽  
Marit Borg ◽  
Larry Davidson
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Social Life ◽  
Future Orientation ◽  
Small Scale ◽  
General View ◽  
First Person ◽  
Content Type ◽  
Substance Use Problems ◽  
Facilitators And Barriers

Purpose – The co-occurrence of mental health and substance use problems is prevalent, and has been problematic both in terms of its complexity for the person and of the challenges it poses to health care practitioners. Recovery in co-occurring mental health and substance use problems is viewed as with multiple challenges embedded in it. As most of the existing literature on recovery tends to treat recovery in mental health and substance use problems separately, it is critical to assess the nature of our current understanding of what has been described as “complex” or “dual” recovery. The purpose of this paper is to identify and discuss what persons with co-occurring mental health and substance use problems describe as facilitators and barriers in their recovery process as revealed in the literature. Design/methodology/approach – The method used for this study was a small-scale review of the literature gleaned from a wider general view. Searches were conducted in CINAHL, Psych info, Medline, Embase, SweMed+, and NORART. Findings – Three overarching themes were identified as facilitators of dual recovery: first, meaningful everyday life; second, focus on strengths and future orientation; and third, re-establishing a social life and supportive relationships. Two overarching themes were identified as barriers to dual recovery: first, lack of tailored help and second, complex systems and uncoordinated services. Originality/value – The recovery literature mostly focuses on recovery in mental health and substance use problems separately, with less attention being paid in the first-person literature to what helps and what hinders dual recovery.

scholarly journals Factors Associated With Use of Mental Health and Substance Use Treatment Services by Justice-Involved Youths

2019 ◽  
Vol 70 (7) ◽  
pp. 586-595 ◽  
Author(s):  
Juliet C. Yonek ◽  
Emily F. Dauria ◽  
Kathleen Kemp ◽  
Daphne Koinis-Mitchell ◽  
Brandon D. L. Marshall ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Treatment ◽  
Factors Associated ◽  
Treatment Services

Suicidality and Treatment Experience Among Young People Who Inject Drugs

2020 ◽  
Author(s):  
Mary Ellen Mackesy-Amiti ◽  
Lawrence J. Ouellet
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Young People ◽  
Mental Disorders ◽  
Mental Health Treatment ◽  
People Who Inject Drugs ◽  
Multivariable Analysis ◽  
Psychiatric Research ◽  
Health Treatment ◽  
The Past

Background. We examined correlates of past year suicidal thoughts and behavior (STB) and described past year treatment experiences among young people who inject drugs (PWID). Methods. Participants were 570 adults (18-25 years) who injected primarily heroin. Interviews were conducted at field stations operated by Community Outreach Intervention Projects in Chicago, Illinois (USA). Interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Substance use and mental disorders were based on DSM-IV diagnostic criteria. Past year STB was based on multiple questions. Results. Sixteen percent of men and 25% of women reported STB in the past year. In multivariable analysis, STB was associated with non-heterosexual orientation, foster care, and being raised by two parents. Primary major depression, post-traumatic stress disorder, other anxiety disorders, and borderline personality disorder had independent effects on suicidality. Among those reporting past year STB (n=111), 83% ever received mental health treatment, while 44% did so in the past year. While 24% of respondents indicated that at least one treatment matched their needs very well, 30% reported treatment that did not match their needs at all. The most common reason for ending treatment was program completion (about 50%) while getting better was endorsed by about 25%. Nearly half reported ending treatment due to a bad experience, logistical issues, or expense. Conclusions. Young PWID are at high risk for suicidal behavior and their mental health treatment experiences often do not meet their needs. There is a pressing need for more integrated substance use and mental health treatment.

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