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Andreas,<br>
<br>
While I was with Community Counseling Centers of Chicago we were
fortunate to have a medical director who implemented a system of
integrated cross
disciplinary case management to address mental illness as well as other
conditions such as addiction. Our client base included a large number,
approximately 2600, homeless individuals referred to us from the many
various shelters and community based medical centers in Chicago.
Accordingly, at the time, we considered ourselves quite successful on
the diagnosis side. <br>
<br>
On the treatment side we had the common mixed results that come with
keeping homeless people on their meds. Otherwise we did a terrific job
using case management and coordination with various housing agencies to
promote community/social reintegration . But we had less success with
our substance abuse programs. We followed a modified 12 step model and
found it to be ineffective in the long term management of relapse. As
you probably know, relapse then would interfere with administration of
Rx protocols.<br>
<br>
It has been some time since I was activity engaged in the industry and
I was never a clinician but, rather, a board member. The question I
have is if the community based mental health is space doing anything
for substance abuse research that is different from traditional 12
step-like programs? Also, what initiatives, if any, are coming from
state agencies such as Medicaid to coordinate publicly funded mental
health organizations with subtonic abuse organizations into overall
case management?<br>
<br>
db<br>
<br>
<br>
<br>
Andreas Schou wrote:<br>
<blockquote type="cite"
cite="mida80566c4050224082944d4000a@mail.gmail.com">
<blockquote type="cite">
<pre wrap="">One more thing: I don't mean to attack addiction, but I find it absolutely
REPUGNANT that there are more resources out there for folks suffering from
addiction than there are for people suffering from neurobiological disorders
over which they never had any control.
</pre>
</blockquote>
<pre wrap=""><!---->
As someone who works with both people suffering from neurobiological
disorders and addicts, I can tell you that the resources for those
suffering from schizophrenia, clinical depression, and severe anxiety
disorders far exceed the resources available to addicts. In those
areas where addiction resources are more readily available, it's
because addicts themselves have organized twelve-step programs.
Of particular note are the people at Adult Mental Health at Latah
County Health and Welfare (shout-out to Doug Salata) and Disability
Action Center (shout-out to Janesta). Between the two, I've had very
few problems getting people with Axis I disorders the help they need
to get out on their own, with a consistent income (often SSI/SSDI) and
a place to stay. In fact, Sojourners' Alliance has higher success rate
with the severely mentally ill than with the homeless population as a
whole. 80% of our schizophrenic clients this year (we've had five)
have graduated to subsidized housing.
Where the problem really lies is in getting dual-diagnosed (mental
health/substance abuse issues) clients the help they need. Often, the
substance abuse providers will diagnose mental health as their
"primary" issue -- because they have little experience dealing with
mentally ill clients -- and the mental health providers will diagnose
substance abuse as their "primary issue." So you'll see a client
that's both mentally ill and a methamphetamine user get a diagnosis
like this: Bipolar II secondary to borderline personality disorder
with methamphetamine abuse. And, whammo, all of the sudden a client
who clearly needs help (but who may not want it) has a diagnosis with
which they can't get any help, whether or not they might someday
realize that they need it.
</pre>
<blockquote type="cite">
<pre wrap="">Of course, I'm a bleeding heart
liberal who wants to help all those who want it, and that includes addicts.
BUT, when employers start limiting health benefits (in part) because of the
high costs of treating addiction, then I think we have an obligation to make
sure those who have illnesses/disorders/diseases over which they have no
control DON'T wind up with the short end of the stick.
</pre>
</blockquote>
<pre wrap=""><!---->
Addicts are often hard to work with. Often, the addiction has covered
for poor coping skills for years. The costs of not treating addiction
are, however, much greater than the costs of treating addiction. If
addicts don't receive the help they need (and since addiction, unlike
many psychiatric disorders, can't be treated with a pill, the costs in
terms of staff time are greater), they end up meeting either myself or
the criminal justice system. The costs of providing effective
outpatient treatment to addicts are far lower than the costs of
providing a room here at Sojourners' or a bunk in state prison ... or,
failing either of those, having the person burglarize your business to
steal money to buy meth.
-- ACS
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</pre>
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