Monday, May 11, 2009

Problems in the field - Working with people with co-occuring disorders

Today, I am starting a new series of articles on the GCASA Cares blog entitled, Problems In The Field. These are issues which cause systemic problems for providers and others.

I am interested in comments about these issues locally, across New York State, and across the country.

The first issue which is a problem in the field is the lack of access to Mental Health Care for people with addiction problems.

While the policy makers pay lip service to co-ordinated care and, as professionals, we know that clients get better outcomes when both disorders are treated concurrently, we find here at GCASA that the waiting lists for mental health care in both counties are over two months long in our county mental health clinics.

There are many reasons for this dearth of services, but there appears to be two primary reasons: lack of trained staff and no money. No money is a primary reason for the lack of trained staff. While a Licensed Clinical Social Worker with 10 years experience can expect to make $35,000.00 in a county clinic, a nurse or a teacher with comparable education and experience, can expect to make a little short of twice that much with better benefits and more vacation.

Reimbursement rates are pitiful now and payors are planning on making reimbursement even more stingy and difficult. Consequently, patients and the treatment system suffers.

The answers?

Better pay for qualified staff who are more willing to work with difficult patients.

Higher reimbursement rates for patients suffering from co-morbid disorders who are more difficult to treat.

Payors and policy makers often ignore the clinical realities of working with such patients placing increasingly difficult regulations and requirements micro-managing service delivery to the point that no self respecting professional finds that working in such a system is professionally satisfying and fulfilling.

The problems in working with people with co-occurring disorders are enormous and I don't see any enlightened policies on the horizon which will make things better any time soon.

Leave your ideas and comments.

This is article #1 in a series on Problems In The Field.

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