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The challenge of integrated care at the programme level 

The challenge of integrated care at the programme level
The challenge of integrated care at the programme level
Oxford Textbook of Community Mental Health

William C. Torrey

and Mary F. Brunette


Adults with severe mental illnesses need integrated mental health and substance abuse treatment programming. The reasons are compelling: 1) approximately half of adults with severe mental illness also experience a co-occurring substance use disorder (Regier et al., 1990), 2) people with co -occurring disorders tend to have worse clinical outcomes, such as increased symptoms, more hospitalizations, and higher rates of infectious diseases, victimization, and homelessness (Dixon, 1999), and 3) separate or fragmented care is not effective (Ridgely et al., 1987). Despite growing awareness of the importance of these services, integrated programmes are still not widely available for people who need them (Epstein et al., 2004; Presidents’ New Freedom Commission on Mental Health, 2003).

Integrated dual disorders treatment (IDDT) is an integrated multidisciplinary team approach to care for adults with co-occurring substance use disorders and severe mental illnesses. The treatment programme grew out of experience with clinical programmes that are effective for this population and has been implemented widely (Mueser et al., 2003). IDDT offers a coordinated package of psychopharmacology, psychosocial interventions, and substance abuse counselling so that those needing the service experience a consistent approach, philosophy, and treatment recommendations.

Essential programme elements include a comprehensive, long-term, stage-wise approach to treatment; assertive outreach; motivational interventions; and strategies and supports to help people learn to manage both illnesses and to achieve their functional goals (Drake et al., 2001).

This chapter reviews the research on implementing IDDT services and provides practical recommendations for organizational leaders who would like to implement and offer integrated programming for people with co-occurring disorders.

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