Skip to main content
SpringerLink
Log in

Perceptions of mental health and substance abuse program administrators and staff on service delivery to persons with co-occurring substance abuse and mental disorders

  • Regular Articles
  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

Several initiatives in the past 20 years have been implemented in Los Angeles County to improve service delivery across the mental health and substance abuse treatment systems, with the goal of increasing access to and coordination of services for individuals with co-occurring substance abuse and mental disorders. To examine the current status of service delivery to this population, a survey was conducted with administrators of mental health and substance abuse programs that provide services to dually diagnosed patients and with the treatment staff in those programs. Administrators (n=15) and staff (n=99) in substance abuse programs rated the accessibility and coordination of services to dually diagnosed patients significantly lower than the mental health administrators (n=10) and staff (n=136). Efforts to coordinate service delivery across the two systems need to address these divergent perceptions between staff in programs that are increasingly called upon to work together to jointly deliver services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hien D, Zimberg S, Weisman S, et al. Dual diagnosis subtypes in urban substance abuse and mental health clinics.Psychiatric Services. 1997;48:1058–1063.

    Google Scholar 

  2. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III—R psychiatric disorders in the United States: results from the National Comorbidity Study.Archives of General Psychiatry. 1994;51:8–19.

    Google Scholar 

  3. Kessler RC, Nelson CB, McGonagle KA, et al. The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization.American Journal of Orthopsychiatry. 1996;66:17–31.

    Google Scholar 

  4. Regier D, Narrow W, Rae D, et al. The de facto US mental and addictive disorders service system.Archives of General Psychiatry. 1993;50:85–94.

    Google Scholar 

  5. Kessler RC, Zhao S, Katz SJ, et al. Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey.American Journal of Psychiatry. 1999;156:115–123.

    Google Scholar 

  6. Dickey B, Azeni H. Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care.American Journal of Public Health. 1996;86:973–977.

    Google Scholar 

  7. Maynard C, Cox GB, Krupski A, et al. Utilization of services for mentally ill chemically abusing patients discharged from residential treatment.Journal of Behavioral Health Services & Research. 1999;26:219–228.

    Google Scholar 

  8. Gonzalez G, Rosenheck RA. Outcomes and service use among homeless persons with serious mental illness and substance abuse.Psychiatric Services. 2002;53:437–446.

    Google Scholar 

  9. Drake RE, Essock SM, Shaner A, et al. Implementing dual diagnosis services for clients with severe mental illness.Psychiatric Services. 2001;52:469–476.

    Google Scholar 

  10. Brown VB, Ridgely MS, Pepper B, et al. The dual crisis: mental illness and substance abuse. Present and future directions.American Psychologist. 1989;44:565–569.

    Google Scholar 

  11. Osher FC, Drake RE. Reversing a history of unmet needs: approaches to care for persons with co-occurring addictive and mental disorders.American Journal of Orthopsychiatry. 1996;66:4–11.

    Google Scholar 

  12. Ridgely MS, Dixon LB. Policy and financing issues in the care of people with chronic mental illness and substance use disorders. In: Lehman A, Dixon L, eds.Double Jeopardy: Chronic Mental Illness and Substance Use Disorders. Langhorn, Pa: Harwood Academic Publishers, 1995:277–295.

    Google Scholar 

  13. Ridgely S, Goldman HH, Willenbring M. Barriers to the care of persons with dual diagnoses: organizational and financing issues.Schizophrenia Bulletin. 1990;16:123–132.

    Google Scholar 

  14. Young, NK, Grella CE. Mental health and substance abuse treatment services for dually diagnosed clients: results of a statewide survey of county administrators.Journal of Behavioral Health Services & Research. 1998;25:83–92.

    Google Scholar 

  15. Drake RE, Mercer-McFadden C, Mueser KT, et al. Review of integrated mental health and substance abuse treatment for patients with dual disorders.Schizophrenia Bulletin. 1998;24:589–608.

    Google Scholar 

  16. Minkoff K. Best practices: developing standards of care for individuals with co-occurring psychiatric and substance use disorders.Psychiatric Services. 2001;52:597–599.

    Google Scholar 

  17. National Association of State Mental Health Program Directors, National Association of State Alcohol and Drug Abuse Directors.National Dialogue on Co-Occurring Mental Health and Substance Abuse Disorders. Alexandria, Va: NASMHPD; 1999.

    Google Scholar 

  18. Barreira P, Espey B, Fishbein R, et al. Linking substance abuse and serious mental illness service delivery systems: initiating a statewide collaborative.Journal of Behavioral Health Services & Research. 2000;27:107–113.

    Google Scholar 

  19. Bevilacqua JJ. New paradigms, old pitfalls.New Directions in Mental Health Services. 1995;66:19–30.

    Google Scholar 

  20. Ross CE, Croze C. Mental health service delivery in the age of managed care. In: Watkins TR, Callicutt JW, eds.Mental Health Policy and Practice Today. Thousand Oaks, Calif: Sage; 1997:346–361.

    Google Scholar 

  21. Sciacca K, Thompson CM. Program development and integrated treatment across systems for dual diagnosis: mental illness, drug addiction, and alcoholism (MIDAA).Journal of Mental Health Administration. 1996;23:288–297.

    Google Scholar 

  22. Drake RE, Wallach MA. Dual diagnosis: 15 years of progress.Psychiatric Services. 2000;51:1126–1129.

    Google Scholar 

  23. RachBeisel J, Scott J, Dixon L. Co-occurring severe mental illness and substance use disorders: a review of recent research.Psychiatric Services. 1999;50:1427–1434.

    Google Scholar 

  24. Watkins KE, Burnam A, Kung F, et al. A national survey of care for persons with co-occurring mental and substance use disorders.Psychiatric Services. 2001;52:1062–1068.

    Google Scholar 

  25. Herman SE, Frank KA, Mowbray CT, et al. Longitudinal effects of integrated treatment on alcohol use for persons with serious mental illness and substance use disorders.Journal of Behavioral Health Services & Research. 2000;27:286–302.

    Google Scholar 

  26. Minkoff K. Program components of a comprehensive integrated care system for seriously mentally ill patients with substance disorders.New Directions for Mental Health Services. 2001:17–30.

  27. Sacks S. Co-occurring mental and substance use disorders: promising approaches and research issues.Substance Use and Misuse. 2000;35:2061–2093.

    Google Scholar 

  28. Wingerson D, Ries RK. Assertive community treatment for patients with chronic and severe mental illness who abuse drugs.Journal of Psychoactive Drugs. 1999;31:13–18.

    Google Scholar 

  29. Carey KB, Purnine DM, Maisto SA, et al. Treating substance abuse in the context of severe and persistent mental illness: clinicians' perspectives.Journal of Substance Abuse Treatment. 2000;19:189–198.

    Google Scholar 

  30. Grella CE, Gilmore J. Improving service delivery to the dually diagnosed in Los Angeles county.Journal of Substance Abuse Treatment. 2002;23:115–122.

    Google Scholar 

  31. Shaw S, Borkman T.Social Model Alcohol Recovery: An Environmental Approach. Burbank, Calif: Bridge Focus Inc; 1990.

    Google Scholar 

  32. Anthony WA, Cohen MR, Cohen BF. Philosophy, treatment process, and principles of the psychiatric rehabilitation approach.New Directions for Mental Health Services. 1983;17:67–79.

    Google Scholar 

  33. Morrissey JP, Calloway M, Bartko WT, et al. Local mental health authorities and service system change: evidence from the Robert Wood Johnson program on chronic mental illness.Milbank Quarterly. 1994;72:49–80.

    Google Scholar 

  34. Morrissey J, Calloway M, Johnsen M, et al. Service system performance and integration: a baseline profile of the ACCESS demonstration sites.Psychiatric Services. 1997;48:374–380.

    Google Scholar 

  35. Zaslav P. The role of self-help groups in the treatment of the dual diagnosis patient. In: Solomon J, Zimberg S, Shollar E, eds.Dual Diagnosis: Evaluation, Treatment, Training, and Program Development. New York: Plenum; 1993:105–126.

    Google Scholar 

  36. Barrowclough C, Haddock G, Tarrier N, et al. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders.American Journal of Psychiatry. 2001;158:1706–1713.

    Google Scholar 

  37. Carey KB. Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach.Community Mental Health Journal. 1996;32:291–306.

    Google Scholar 

  38. Roberts LJ, Shaner A, Eckman TA.Overcoming Addictions: Skills Training for People with Schizophrenia. New York: WW Norton; 1999.

    Google Scholar 

  39. Ziedonis DM, Trudeau K. Motivation to quit using substances among individuals with schizophrenia: implications for a motivation-based treatment model.Schizophrenia Bulletin. 1997;23:229–238.

    Google Scholar 

  40. Jerrell JM, Ridgely S. Comparative effectiveness of three approaches to serving people with severe mental illness and substance abuse disorders.Journal of Nervous and Mental Disease. 1995;183:566–576.

    Google Scholar 

  41. Jerrell JM, Hu T, Ridgely MS. Cost-effectiveness of substance disorder interventions for people with severe mental illness.Journal of Mental Health Administration. 1994;21:283–297.

    Google Scholar 

  42. Zimberg S, Solomon J, Shollar E, et al. Developing dual diagnosis treatment services within existing outpatient psychiatric and addictive disorder programs. In: Solomon J, Zimberg S, Shollar E, eds.Dual Diagnosis: Evaluation, Treatment, Training, and Program Development. New York: Plenum; 1993:253–270.

    Google Scholar 

  43. Grella CE. Contrasting the views of substance misuse and mental health treatment providers on treating the dually diagnosed.Substance Use and Misuse. 2003;38:1433–1446.

    Google Scholar 

  44. Zweben JE. Severely and persistently mentally ill substance abusers: clinical and policy issues.Journal of Psychoactive Drugs. 2000;32:383–389.

    Google Scholar 

  45. Jerrell JM, Wilson JL, Hiller DC. Issues and outcomes in integrated treatment programs for dual disorders.Journal of Behavioral Health Services & Research. 2000;27:303–313.

    Google Scholar 

  46. Coffey RM, Graver L, Schroeder D.Mental Health and Substance Abuse Treatment: Results From a Study Integrating Data From State Mental Health, Substance Abuse, and Medicaid Agencies. Rockville, Md: Substance Abuse & Mental Health Services Administration, CSAT; 2001. DHHS Pub. No. (SMA)01-3528.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UCLA Drug Abuse Research Center/Integrated Substance Abuse Programs, 1640 S Sepulveda Blvd, Suite 200, 90025, Los Angeles, CA

    Christine E. Grella PhD & Leslie Cooper PhD (Project Director)

  2. the Department of Psychology, University of North Carolina, Charlotte

    Virginia Gil-Rivas PhD (Assistant Professor)

Authors
  1. Christine E. Grella PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Virginia Gil-Rivas PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leslie Cooper PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine E. Grella PhD.

Additional information

when this work was completed

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grella, C.E., Gil-Rivas, V. & Cooper, L. Perceptions of mental health and substance abuse program administrators and staff on service delivery to persons with co-occurring substance abuse and mental disorders. The Journal of Behavioral Health Services & Research 31, 38–49 (2004). https://doi.org/10.1007/BF02287337

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02287337

Keywords

Search

Navigation