System Fails Patients With Comorbid Disorders

APA is hoping that a strongly worded report on co-occurring substance abuse and mental disorders, submitted to Congress last month by the Substance Abuse and Mental Health Services Administration (SAMHSA), will provide a much-needed boost in the fight to enact parity legislation.

In a prepared statement, APA President Paul Appelbaum, M.D., said, “This report is clear: effective mental health treatment exists, and people with co-occurring disorders can and do recover with appropriate treatment and support services.”

The congressionally mandated report also found many longstanding systematic barriers to treatment and support services for individuals with co-occurring disorders, including separate administrative structures, eligibility criteria, and funding streams, as well as limited resources for both mental health services and substance abuse services.

The report, prepared by SAMHSA for the Department of Health and Human Services (HHS), calls for the creation of a system in which “both disorders are addressed as primary and treated as such.” It also contains a five-year outline, or “blueprint for action,” aimed at improving opportunity for recovery by increasing the availability of quality prevention, diagnosis, and treatment services for individuals with co-occurring disorders.

“This report tells us that individuals with co-occurring disorders should be the expectation, not the exception, in the substance abuse treatment and mental health services systems,” noted HHS Secretary Tommy Thompson at a press briefing in which he released the report. “The blueprint for action outlines how we will work in partnership with the states and local community providers to improve access to integrated services and treatments and find ways to pay for this care.”

At that briefing, SAMHSA Administrator Charles Curie emphasized, “If one co-occurring disorder goes untreated, both usually get worse, and additional complications often arise, including the risk of other serious medical problems, suicide, unemployment, homelessness, incarceration, and separation from families and friends. People with co-occurring disorders cannot separate their addiction from their mental illness, so they should not have to negotiate separate service delivery systems.”

APA was generally pleased with the blueprint, which among other recommendations calls for creating the SAMHSA-funded State Initiative Grant for Co-occurring Disorders to help states enhance their infrastructure and treatment systems. The report also calls for the establishment of a national technical assistance and cross-training center devoted to prevention and treatment of co-occurring disorders.

SAMHSA also hopes to convene a national summit on co-occurring disorders to help states and communities share practices and lessons learned, as well as to promote discussion of initiatives and cross-funding opportunities with federal partners and key stakeholders.

Appelbaum noted that lack of parity is a significant barrier to accomplishing the goals of the report. “APA believes,” he said, “that the report provides important support for our advocacy to alleviate the current fragmented mental health delivery system, provide adequate funding in the public health system, and increase the supply of psychiatrists in underserved areas.

“Clearly,” he continued, “the SAMHSA report further justifies APA’s advocacy of the critical need to pass comprehensive mental health parity legislation. We are hopeful that the report, which echoes APA’s concerns, will provide the President’s New Freedom Commission on Mental Health with the incentive to address the critical need for a comprehensive health parity bill.”

The SAMHSA report is posted on the web at www.samhsa.gov/news/cl_congress2002.html. ▪