Integrated Treatment for Co-occurring Mental Health and Substance Use Disorders

MDCH recognizes that there is a growing concern among consumers, families, and other stakeholders regarding Co-occurring Mental Health and Substance Use Disorders. It is an expectation that individuals with co-occurring disorders have multiple issues that are characterize by - not only co-occurring mental health and substance use disorders, but also developmental disabilities and medical, legal, housing, trauma, domestic violence, educational, and other social issues. Both the mental health system and the substance abuse system are traditionally designed to operate isolated from one another, with structures, funding, rules and regulations, clinician training, and clinical practices that were not designed for the degree of complexity individuals and families present with every day. 

Most simply stated, the vision is to create a welcoming, person-centered, recovery oriented, culturally competent, trauma-informed, co-occurring capable system that is created through stakeholder partnerships reflecting the spirit and capacity of our shared values to serve consumers of the public mental health and substance abuse system. This vision holds the promise of creating, dynamic, enduring, and interrelated systems that:

  • Welcome individuals with complex needs into hopeful, caring and integrated relationships,
  • Support recovery through empowered partnerships focused on individualized goals,
  • Organize all staff to deliver effectively matched services in every setting to help individuals with complex needs achieve their recovery goals.

In Michigan, funding for mental health services flows through Commmunity Mental Health Services Programs (CMHSPs) and Prepaid Inpatient Health Plans (PIHPs), which primarily serve people with serious mental illness. People who receive Medicaid and have a less serious mental illness are eligible for a limited outpatient mental health benefit through the Medicaid Health Plan.

Substance abuse funding, except for Medicaid, is contracted directly between MDCH and Substance Abuse Coordinating Agencies (CAs) which serve, people with substance disorders through subcontract agencies. Medicaid funds for substance abuse services are contracted with PIHPs, which typically subcontract those funds with CAs (some PIHPs also serve as CAs).

Efforts are underway to improve the system of care for people who have both a mental illness and a substance use disorder.

In Michigan, MDCH uses the principles of the Continuous, Comprehensive Integrated System of Care (CCISC) model developed by Dr. Ken Minkoff and Dr. Chris Cline to effect systems change. To develop a successful and sustainable change, PIHPs must look at the entire system of care and develop a comprehensive plan that addresses co-occurring disorders and integrated treatment.

In June 2004, MDCH came together with the PIHPs, major universities, and other stakeholders, to discuss improving clinical practices in the public mental health system. This group, the Practice Improvement Steering Committee (PISC), decided support the implementation of federal Substance Abuse and Mental Health Administration (SAMHSA) approved Evidence-Based Practices (EBPs) in Michigan, including the Integrated Dual Disorders Treatment model.

Co-occurring Disorders: Integrated Dual Disorders Treatment (COD:IDDT) model is for people who have serious mental illness and have a co-occurring substance use disorder who are served in the mental health system. This treatment approach helps people recover by offering treatments that combine or integrate mental health and substance abuse interventions at the level of the clinical encounter. This means the same clinicians or teams of clinicians, working in one setting, provide appropriate mental health and substance abuse interventions in an integrated fashion. In other words, the caregivers take responsibility for combining the interventions into one coherent package. For the individual with a co-occurring disorder, the services appear seamless, with a consistent approach, philosophy, and set of recommendations. The need to negotiate with separate clinical teams, programs, or systems disappears. The goal of COD:IDDT, is recovery from two serious illnesses. A wide variety of services are offered in a stage-wise fashion because some services are important early in treatment, while others are more important later on. Individualized treatment is offered depending on what stage of recovery a person is in. Services are offered in a positive atmosphere and people are encouraged to believe that they can recover as many others have. Ultimately, the goal of Integrated Dual Disorders Treatment (IDDT) is to help people manage both their mental illness and substance disorders so that they can pursue their own meaningful life goals.

PIHP representatives, Substance Abuse Coordinating Agency representatives, MDCH staff, consumers, advocates, and educators continue to come together in the COD:IDDT subcommittee to work toward the implementation of Integrated Treatment for Co-occurring Mental Health and Substance Use Disorder capability throughout the public mental health and substance abuse system in the State of Michigan. 

 

 

MDCH Communications

 

For more information on Co-occurring Disorders, please visit:

 

Integrated Treatment for Co-Occurring Disorders Evidence Based Practices Kit

For more information contact:  Mark Lowis, LMSW at Lowism@michigan.gov