To foster the implementation of integrated approaches for New York State residents with co-occurring mental health and substance abuse conditions.

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Program Structure – Typically, an agency’s mission statement and policies are inclusive of persons with co-occurring disorders. When a program is not licensed to provide both mental health and addiction treatment services, a formal process will be established to ensure that individuals have access to those services that are not provided by the agency, and that concurrent services are integrated. For substance abuse programs, this often entails collaboration with a mental health program; mental health settings will likewise collaborate with a substance abuse program.

Program Milieu – The milieu is defined by the program’s expectations and the routine welcome given to those with co-occurring conditions and expressed in the treatment of both disorders. The program should display, distribute, and use literature and client/family educational materials that address both mental health and substance use disorders.

Program Structure

The mission statement and/or policy will include persons with co-occurring disorders.

Programs that provide “addiction only” or “mental health only” services often have a more traditional mission statement, such as: “The [Program Name] is dedicated to assisting persons with alcohol and drug problems regain control over their lives.” A change in a mission statement is emblematic of a “sea change” in leadership philosophy and commitment. A subtle shift in the mission statement to: “The [Program Name] is dedicated to assisting persons initiate a process of recovery from substance use and its associated problems” begins to position the Addiction Only/Mental Health Only program as “Dual Disorder Capable” (“DDC”) or “Co-occurring Capable,” able to support to both mental health and addiction conditions.

If a program is not licensed to provide both mental health and addiction treatment services, a formal process has been established to ensure that individuals have access to services that the agency does not provide, and that those services are integrated.

Programs with a concentration on only addiction or only mental health services tend to have an informal relationship with the local provider of concurrent (mental health or addiction) services, if they have any association at all. To achieve co-occurring disorders capable (“Dual Disorder Capable” or “DDC”) status, programs must develop more formalized procedures and protocols to coordinate services for persons with co-occurring disorders. To be considered “Dual Disorder Capable,” a single-service agency might begin by holding a series of meetings with another single-service agency that offers complementary services, culminating in a memorandum of understanding (MOU) that describe admission, transfer and referral procedures. Monthly meetings between program coordinators and designated intake clinicians would be initiated to review the new protocols and discuss plans for common patients. In achieving “Dual Disorder Capability,” an Addiction [Mental Health] only program moves from using a loosely structured, clinician-driven consultation model to obtain concurrent services to one that establishes a collaboration between at least one other agency to include the full range of services necessary to support the needs of persons with co-occurring conditions.

CEIC Experience in New York State – Mission statements generally do not reflect the fact that most programs are indeed providing some type of service or treatment to individuals with co-occurring disorders. Programs are enthusiastic about making changes, but are unsure about the language to use to maintain consistency with their license. CEIC technical assistance helps to resolve this concern by suggesting language to convey that the other (co-occurring) condition is treated within the context of primary treatment.

Program Milieu

The literature and educational materials for clients/families that a program displays, distributes, and uses relate to both mental health and substance use problems.

“Addiction only” and “mental health only” programs that aspire to become “Dual Disorder Capable” should provide brochures and literature in their waiting rooms that describe psychiatric problems (e.g. depression), substance abuse problems, and co-occurring disorders–this will decrease the stigma and elevate the status of each disorder. The same subjects should be raised routinely in orientation sessions, community meetings, “rap” sessions, and family visits. In doing so, programs explicitly convey a welcoming attitude and acceptance of persons with co-occurring disorders.

CEIC Experience in New York State – Program and individual clinicians usually expect and welcome individuals with both mental and substance use problems to treatment. Typically, literature and client educational materials are available for the primary problem, but are much less comprehensive and accessible for the co-occurring condition. CEIC’s post-site-visit feedback indicates that programs are actively working to broaden their client literature to encompass both areas of concern, substance use and mental health.

CEIC Program Structure & Milieu Resource

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