Integrated Model Of Care

Concurrent disorders (clients with mental health and addiction) have different treatment needs for a number of reasons and one reason is that they differ in terms of their mental health diagnoses and their substance abuse. To illustrate this, consider the client who is diagnosed with anxiety and they use marijuana versus the client who has bi-polar disorder and they use cocaine (Courseware). The symptoms of their mental health are very different as are the drugs and the reactions of the drugs on their mental health (cocaine is a stimulant and alcohol can be both a stimulant and sedative depending on the amount being ingested).

Substance abuse has been a known topic which has not been recognized and fully treated the way it should. Unlike general medicine, substance abuse treatments have their own facility and services apart from general settings, making it harder to get the recognition and the assistance needed to help the individuals in need. Both the Affordable Care Act and the Substance Abuse and Mental Health Service Administration (SAMHSA), which is a part of the US Department of Health and Human Services have promoted and established ways to enhance the quality of the treatment and the amount of treatment given.

The final item of business brought up was the vision for system integration in behavioral health. There was plenty of discussion focused on this since it is a new introduction but a much needed policy that needs to be put into place. Included in this discussion was the possibility of implementing behavioral health homes in Nebraska. Many other states have implemented behavioral health homes and some have worked out well and others have failed. One member brought up the big picture concern of behavioral health homes and how they are to take care of those with multiple morbidities since they are very complicated patients and healthcare workers tend to shy away from them. Nobody knew the answer to solve this concern but the committee planned how they should be thinking about what approach to take to make the behavioral health system more integrated. Today’s discussion about the vision for system integration was just the beginning of what is going to be handled at the next meeting.

Physical health and behavioral health care are typically delivered in separate settings by different providers, often with little collaboration and coordination. This fragmented health care delivery system leads to care deficiencies, specifically for individuals with mental and physical health co-morbidities (Enthoven, 2009). Individuals with mental and substance abuse disorders may die decades earlier than the average person — often from untreated and preventable chronic diseases (Substance Abuse and Mental Health Administration [SAMSHA], 2017). Evidence indicates that the health care system is improving care delivery for members with co-morbidities through the integration of physical and behavioral health care (Enthoven, 2009).

Based on my experiences working with individuals involved in the criminal justice system, those suffering from co-occurring disorders is common. With the current opiate epidemic we are facing, I have come across a majority of individuals who are both opiate depended, as well as having a psychiatric diagnosis consisting of either, or both, depression and anxiety. When trying to provide services for these individuals, both their substance abuse and psychiatric issues need to be addressed. To be most effective, they need to be treated at the same time through integrated treatment. Based on the concept of “No wrong door”, the client will be provided with services to make sure they receive the appropriate treatment. After the client is assessed

An integration of care study was conducted by a Doctor of Behavioral Health Intern at Michael R. Zent (MRZ)Healthcare Clinic in Phoenix, Arizona. MRZ is a reverse co-located integrated medical and behavioral clinic that provides services to about 4000 children and 4000 adults annually. MRZ provides laboratory, pharmacy, behavioral and physical health services together under one roof. The clinic utilizes an integrated electronic health record to document the treatment of members. The focus of the integration of care study was to understand and assess the barriers and challenges of the integration of care methodology at MRZ.

Substance abuse and additions: One of the unique ethical challenges involves the myriad of dual relationships inherent in the field and include dilemmas stemming from recovering workers attending AA meetings with clients or with their supervisors, or the changing role of some individuals to service providers within the very programs in which they had recently been clients. Dual relationships are a concern frequently addressed in the substance abuse literature (e.g., see Bissell and Royce, 1989). Additional challenges arise from the increased use of physical contact in treatment between clients and service providers, the hinging of services to abstinence, and the debates surrounding abstinence versus controlled drinking and harm reduction,

Drug addiction and mental illness are two topics that are becoming more popular for discussion in American households. As stated from DrugAbuse.com, “mental illness is common amongst a population suffering from substance abuse and addiction. The relationship is so strong that many people believe the drugs play a causative role in the development of the mental illness. In most instances, this is not the case. In the United States, approximately 8.9 million people have both a mental health and a substance abuse issue”. This overwhelming amount of the United States population is often give as a dual diagnosis making persons suffering

Co-occurring disorders are described as a person having the presence of two or more disorders at one time. Estimates suggests that up to 7 million people in the United States have a combination of at least one co-occurring mental health and substance related disorder in any given year (US Department of Human Services, 2003). Research shows that a person’s mental health condition should not be overlooked when treating for substance abuse (Green, Noordsy, Brunette, & O'Keefe, 2008). Integrated treatment as an organizing concept began in the 1980s when it was observed that clients with co-occurring disorders were highly unlikely to receive treatments for both mental health and substance use problems under the existing circumstances

With such a high cost to the nation, and so many people left untreated, there remains a large gap that needs to be addressed. Because substance abuse disrupts so many aspects of life, treatment is very complex. An effective program requires cessation of the drugs, maintaining a drug-free lifestyle, and being a productive, functioning member of society, as well as close follow up (NIDA, 2009).

Over the years there have been many transformations in the treatment of mental health and substance abuse disorders. There is no treatment plan that will work for every individual; similarly, there is not one treatment environment that will be successful for every individual either. “Recognizing that substance abuse is a chronic disorder similar to diabetes, hypertension, and asthma led the panel to question the acute care model of service delivery that has characterized substance abuse treatment for the past 50 years” (McLellan et al. 2000). Intensive outpatient treatment programs have become the primary treatment environment for those with substance abuse disorders due to the fact these programs more cost-effective than other programs. Intensive

substance abuse, the people are seen as nested in numerous systems . Kaufman (1999), highlights that an individual with a substance abuse problem , can have as members as his unique ecosystem, family members, peers , treatment providers, non family members from different sources or legal system.

Screening is a quick overview, which comprises a single measurement, done for the explicit intention of determining whether deeper diagnostic assessment is necessary or warranted. Screening supports in identifying the possibility that a client has co-occurring substance abuse and mental disorders or that his or her presenting signs, symptoms, or behaviors may be influenced by co-occurring issues. The purpose is not to establish the presence or specific type of such a disorder, but to establish the need for an in-depth assessment. Screening is a formal process that typically is brief and occurs soon after the client presents for services. Integrated screening seek to answer identify if there are comorbidity is by asking yes or no questions.

Looking at health care around the world demonstrates that no matter what type of health care is being employed – socialist, capitalist or a blending of the two – there are system wide changes that may be implemented. Within their study, Koch, Miksch; Schürmann; Joos & Sawicki (2011) reported in table 2, that 71% of Canadian physicians feel that fundamental changes have to be made to the health care system for it work better (Koch, Miksch, Schürmann, Joos, & Sawicki, 2011). Mery, et al. (2015) suggest that integrated care would reduce fragmentation and duplication of services while improving patients’ experiences (Mery, et al., 2015, p. 136). “Provider cohesion” is mentioned as being fundamental in the care of elderly

Behavioral Treatment for Substance Abuse in Serious and Persistent Mental Illness (BTSAS) is a comprehensive behavioral treatment model that has been shown to decrease substance use in individuals with serious and persistent mental illnesses (SPMI), people with a traditionally high incidence of co-occurring disorders. For those with SPMI, substance use disorders are associated with greater impairment including: “severe psychiatric symptoms, worse clinical outcomes, poor medication compliance, frequent relapses and hospitalizations, as well as higher rates of violence, suicide, and homelessness” (Tenhula, Bennett, and Kinnaman, 2009, p.832). Therefore, the availability of practical and effective treatment modalities are of the utmost importance