Initiatives and Policies for Integrated Services

In May 2007, the New York State Office of Mental Health (OMH) and the New York State Office of Alcoholism and Substance Abuse Services (OASAS) joined together to create the statewide task force on co-Occurring Disorders. The goal of the Task Force is to improve services across both agencies (OMH and OASAS) for individuals with co-occurring mental health and substance use disorders living in New York State.

The Dual Recovery Coordinator (DRC) Demonstration Program is a New York State initiative in 14 counties and New York City. The initiative created county-level positions that work with local providers to integrate mental health and substance use services. The dual recovery coordinators work to integrate treatment programs, develop infrastructure and networks across substance use and mental health agencies, provide staff training, and mediate conflicts resulting from service integration.

The Western New York Care Coordination Project (WNYCCP) is a consortium of six counties in Western New York State: Chautauqua, Erie, Genesee, Monroe, Onondaga, and Wyoming. The project serves nearly 3,000 adults with severe mental illness through its network of 12 local nonprofit care coordination agencies. WNYCCP focuses on creating a peer and family driven system focused on recovery.

Originally established in 1993 as an interest group of the Chemical Dependency Providers in Orange County, New York, this initiative quickly expanded its focus to become a Mental Illness and Chemical Addiction Task Force. As the task force developed, its work extended outside the boundaries of Orange County and the group became the Mid-Hudson Dual Recovery Task Force.

The mission of Quality IMPACT, a program of the New York City Department of Health and Mental Hygiene, is to implement data driven quality improvement efforts across the New York City service system. Part of this process is the completion of Continuous Quality Improvement (CQI) programs by service providers, which include training, technical assistance and support from experts and New York City Department of Health and Mental Hygiene staff.

Initiated in 2003, the Federal Substance Abuse and Mental Health Services Administration (SAMHSA) Co-Occurring Center of Excellence (COCE) Co-Occurring State Initiative Grants (COSIG) program has provided 19 states with funding for statewide initiatives to improve services for people with co-occurring disorders.

The Federal Substance Abuse and Mental Health Services Administration (SAMHSA) Co-Occurring Center of Excellence’s Policy Academy States program is focused on improving care for individuals with co-occurring substance abuse and mental health disorders. States included in the program worked to develop action plans to address policy and regulatory barriers to integrating co-occurring disorders at a systems level. New York State was included in the third Policy Academy Cohort awarded in 2005.

Sponsored by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment, Partners for Recovery (PFR) encourages collaboration among the wide range of organizations providing services to people with substance use and mental health disorders.

The Mental Health Court Program is a joint venture between the Bureau of Justice Assistance (BJA) and SAMHSA. The program provides funding and support to communities seeking to establish Mental Health Courts (MHC), which have a specialized system that provides an alternative to traditional court proceedures for individuals with mental health disorders in the criminal justice system. Most programs incorporate court-supervised, community-based treatment programs and regular status hearings for each defendant.

In April 2002, President George W. Bush established the President’s New Freedom Commission on Mental Health with the mission of conducting a “comprehensive study of the United States’ mental health services delivery system” identifying policies that could be implemented by Federal, State, and local governments to maximize the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. After one year of study, the commission released its report Achieving the Promise: Transforming Mental Health Care in America.

The Missouri Foundation for Health’s Mental Health and Substance Abuse (MHNSA) program was created to provide grants to Missouri organizations that focus on integrating mental health and substance use services.

Closing the Addiction Treatment Gap is a $10-million national program of the Open Society Institute. This initiative is designed to create an awareness ofand increase resources to closethe alarming treatment gap: four out of five Americans who need drug and alcohol addiction treatment are unable to get it. The initiative aims to mobilize public support for expanded treatment by increasing public funding, broadening insurance coverage for substance use, and achieving greater program efficiency.

The Substance Abuse Policy Research Program (SAPRP) is a $66 million Robert Wood Johnson Foundation (RWJF) initiative that focuses on analyzing and informing public and private policies aimed at reducing the harm caused by alcohol, drugs, tobacco, and multiple-substance use. The initiative seeks to work with experts in public health, law, political science, medicine, sociology, criminal justice, economics, psychology, and other behavioral and policy sciences to address issues related to substance use.

The Robert Wood Johnson Foundation (RWJF) has awarded $2.2 million in grants to six state-provider partnerships through Advancing Recovery: State/Provider Partnerships for Quality Addiction Care.

MacArthur Foundations’s Mental Health Grantmaking strategy  focuses on improving access to effective mental health services by helping to move the most promising advances from research into policy and practice.

Integrated Dual Disorders Treatment (IDDT) is an evidence-based practice that is multi-disciplinary and combines pharmacological, psychological, educational, and social interventions to address the needs of persons with co-occurring mental health and substance use disorders. In this treatment model, a single practitioner or team provides mental health and substance use services at the same time, and in one setting.

The American Society of Addiction Medicine developed Dual Diagnosis Capable (DDC) and Dual Diagnosis Enhanced (DDE) program guidelines as a framework for treating individuals with co-occurring mental health and substance use disorders. The DDC/DDE model is anchored in a substance use treatment framework in which the individual is treated by a single clinician or team in a single setting for both substance use and mental health disorders. Both program models focus on treating substance use disorders, with DDC programs treating those with stable diagnostic co-occurring mental health disorders and DDE programs serving those with unstable or disabling co-occurring mental health disorders.

Assertive Community Treatment (ACT) is a unique form of case management targeted at individuals with the most difficult to treat mental illnesses. Services are provided by a multi-disciplinary team of six to eight staff members from the fields of psychiatry, nursing, and social work, and other professionals, such as substance use treatment and vocational rehabilitation providers. The integrated treatment plan is tailored to meet the needs of each recipient, and progress is monitored and adjusted throughout the course of treatment. Staff-to-recipient ratios are low, and caseloads are shared among the staff. Services are available 24 hours a day for as long as needed, and are often provided in the recipients’ natural living setting.