May 2008

Integrated Services: Ensuring There is "No Wrong Door" for Individuals With Co-Occurring Disorders

The facts on New Yorkers who suffer from mental health and substance use disorders are alarming:

• more than 1.3 million New Yorkers (one in every 20 persons) suffer from co-occurring mental health and substance use disorders;

• more than 60% of New Yorkers with a claim for a substance use disorder also had a psychiatric disorder; and

• more than 50% of persons with schizophrenia also have a substance use disorder diagnosis.

Yet, services provided are often not responsive to people with co-occurring mental health and substance use disorders. For decades, the systems of care have operated separately and have been constrained by regulatory and financial barriers to integration, costing the State tens of millions of unnecessary dollars and resulting in less-than-adequate health outcomes.

Recognizing the consequences of this uncoordinated system of care, the New York State Health Foundation (NYSHealth) is committing $10 million to support efforts to integrate services for these co-occurring illnesses. Working with our partners at the New York State Office of Mental Health (OMH) and the New York State Office of Alcoholism and Substance Abuse Services (OASAS), NYSHealth hopes to remove the barriers of a fragmented health, mental health, and substance use system by first and foremost: increasing the percentage of providers that offer integrated services that address both substance use and mental health problems.

The keystone to this effort is an allocation of $2 million over the next four years to establish a Center of Excellence for the Integration of Care for Individuals with Co-Occurring Mental Health & Substance Use Disorders. One of the Center’s chief objectives will be to implement best practices in integrated screening, assessment and treatment plans in New York State’s 526 OMH- and 697 OASAS-certified clinic programs.

The Center’s ultimate goal is to ensure there is “no wrong door” for people accessing care in either of these systems and that integrated services are continuous and seamless for individuals receiving care. This will lead to both lower costs in the long run and better health outcomes for those suffering from co-occurring disorders.

As part of the Center's infrastructure, NYSHealth will make up to $3 million in grants to help clinics integrate services. Currently, more than 1,000 clinics provide mental health or substance use services, but few provide both types of services. We hope that hundreds of clinics take on the challenge of integrating service over the next four years.

There is yet another challenge that should be considered as we work to improve the integration of mental health and substance use services: access to primary care for people dealing with these challenges. Most people who struggle with co-occurring disorders also have medical care issues, and the State should take steps to ensure these vulnerable citizens’ primary care problems are addressed. For example, if one’s diabetes is not controlled or if one is suffering pain due to dental problems, it is difficult to focus on the challenge of working to address the problems of mental health and substance use.

New York State has almost always stood head-and-shoulders above the rest of the country—including Washington—in its ability to quickly recognize health care trends and adapt accordingly. Integration of treatment for substance use and mental health disorders is an area where New York previously lagged, but we are hopeful that NYSHealth’s commitment to this priority area will be a step toward reclaiming the State’s role as a pioneer in health care.

James R. Knickman, President and CEO