homeless population with a mental illness also have substance disorders.
Dually-diagnosed clients have been characterized as systems misfits with poor outcome,more relapses, more acting out behavior, and more likelihood of being homeless.
Despite the documented high prevalence of co-existing mental illness andsubstance disorders, and the serious consequences, facilities that providecomprehensive services for dual/multiple disorders are limited as compared toservices for singular disorders.Mental health and substance abuse providers alike encounter difficulties inaccessing comprehensive services for dually-diagnosed clients. The underlyingreasons include the following:1.
Bureaucracies are divided according to individual categories of disorderswith segregated admissions criteria, treatment programs, services andreimbursement;2.
providers are educated and trained to deliver services for single, discretedisorders only;
treatment approaches across these disorders are incompatible and differ inmethod and philosophy.
The project the authors have initiated addresses each of the three underlyingissues outlined above. In this article the authors will discuss a model of programdevelopment that has integrated the mental health and substance abuse systems inthe Jackson-Hillsdale counties of Michigan. The authors will review program andstaff development accomplished through an interagency process of cross-trainingand program implementation.
This has resulted in comprehensive services atmultiple sites within the mental health and substance abuse service deliverysystems. This will be followed by an overview of a non-confrontational treatmentmodel
and accompanying philosophy developed specifically for persons whohave dual disorders.
Assessment of Service Needs
Following a critical suicide attempt in April 1991, the Jackson-HillsdaleCommunity Mental Health Board Chief Executive Officer and the ExecutiveDirector of the South Central Michigan Substance Abuse Commission (a regionalauthority), reviewed statistics on substance abusing clients who also presentedthemselves in psychiatric crisis. The community mental health center provided24-hour, 7-day a week emergency services which included face-to-faceassessment of persons entering the emergency room at the general hospital. Amajor focus of this assessment was to determine the need for inpatient psychiatriccare or other alternative treatment services. The Michigan Mental Health Code
specifies that to be elegible for inpatient care individuals must be severelymentally ill and a danger to self/others/unable to care for their basic needs. TheMichigan Public Health Code also states that emergency rooms must offer