Sunday, February 8, 2009

Biggest barrier to treating co-occurring disorders - money

ASAP, the Alcholism and Substance Abuse Providers of New York State sponsored a study to review the practice of 153 providers in New York State who provide services to people experiencing substance abuse and psychiatric disorders. People who struggle with both substance abuse and psychiatric disorders are referred to as MICA, Mentally Ill Chemical Abusers, or people experiencing "co-occuring disorders".

Of the 153 ASAP providers providing services for people with co-occurring disorders, 103 returned surveys with a return rate of 76%.

The biggest barrier to agencies providing co-occurring services is reimbursement policies. Simply put, there is no money in it.

The second biggest barrier was lack of trained staff. Trained staff who can competently deal with substance abuse and psychiatric disorders tend to be more highly trained and experience. They command and deserve higher salaries something which most substance abuse agencies are not able to pay.

Improving services to people struggling with co-occurring disorders is not rocket science even though the bureaucrats dither endlessly. It will reguire some regulatory changes allowing agencies to become dually licensed to provide both substance abuse and psychiatric services so they can become reimbursed for these services. Hopefull the higher reimbursement will provide resources to hire competent staff. Until these changes occur not much is likely to happen that will significantly change the quality and effectiveness of services.

At GCASA we struggle to provide services to people with co-occurring disorders. We have what the jargon of the study calls, DCC, Dual Diagnosis Capable, as distinguished from AOS, Addiction Only Services, and DCE, Dual Diagnosis Enhanced. GCASA has made investigatory efforts to develop Dual Diagnosis Enhanced Services but having the psyciatrist on staff was too expensive and GCASA's inablility to bill for his services since we are not Mental Health Licensed made it financially necessary to reduce our services to DCC. However, our medical director, a family medicine physician does provide a great deal of psychotropic medications until we are able to get patients seen in the County run mental health clinics. We also have L.C.S.W.s, Licensed Clinical Social Workers who provide a great deal of mental health services in our specially designed MICA program.

The Co-Occurring Committee Survey Report dated January, 2009 is available and I am happy to send you a copy if you email me at


David G. Markham said...

The commissioners at New York State level, OASAS, and OMH are talking a good game, but the resources are woefully lacking as the State experience its budget problems.

I was told last week that the county mental health clinic in Orleans County is not seeing new patients until the end of March. One of our counselors at GCASA tried to get an appointment for one of our clients. How can somebody wait two months for a mental health appointment and then the Commissioners talk about collaborative care, let alone coordinated care? You can't "coordinate care" that doesn't exist because one of the partners isn't providing any.

I am curious about the lack of comments on this blog. Your comments are welcomed and appreciated.

All the best,

David Markham

Emma Cay said...

Thanks for sharing. I I can't thank you enough for your work in this field. My best friend has been fighting mental illness and a sex addiction her whole life. Its been an extremely tough road. I really want to get her into a co-occurring disorders treatment center so she can finally get the help she needs.