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Fulfill the Promise of Truly Integrated Care

More than two decades have passed since the adage about co-occurring mental health and substance use disorders being “the expectation, not the exception” became a common refrain at national behavioral health conferences. Certainly much progress has been made in integrating the once-siloed disciplines of psychiatry and addiction treatment, particularly in how most government agencies are now structured to incorporate oversight of both mental health and substance use services.


Yet at the patient care level, the evidence remains clear that not enough has been done to achieve truly integrated behavioral health treatment. As recently as 2017, the proportion of U.S. adults with a co-occurring substance use disorder and a serious mental illness who were receiving both mental health and substance use treatment was a shockingly low 12%, according to the National Survey on Drug Use and Health.


Some programs that claim to offer integrated behavioral health care still treat mental illness and addiction sequentially, or believe the need for integrated care applies only to a small subset of their patient population. In other mental health provider agencies, active substance use remains a disqualifying factor for receiving any care at all.


But several factors in the industry are bringing about a renewed awakening to the need for enhanced services for vulnerable individuals with co-occurring disorders. The emergence of the Certified Community Behavioral Health Clinic (CCBHC) model has highlighted the importance of delivering services that are fully integrated, both within behavioral health and also integrated with primary care. The attention to the specific needs of vulnerable special populations, including racial minorities, the incarcerated, and the LGBTQ community, has brought to light the high prevalence of co-occurring disorders in these groups.


Perhaps no factor has contributed more to the increased awareness than the opioid crisis and the widespread threat of fentanyl’s presence. With data showing a high prevalence of co-occurring opioid use disorder in patients with mental illness, and vice versa, it has become clear that integrated care will prove essential to mitigating the threat of relapse and potentially fatal overdose in these individuals.


Fortunately, many government agencies and treatment providers have come to understand that the effort to bring about fully integrated mental health and substance use treatment is far from over. Many also have discovered that improving providers’ technological capabilities becomes a crucial component of this effort.


For example, as part of New Jersey’s newly approved renewal of its Section 1115 Medicaid demonstration program, state officials have prioritized the need to enhance behavioral health treatment providers’ technological infrastructure. Under the federally approved waiver’s “Behavioral Health Promoting Interoperability Program,” New Jersey behavioral health providers that have a client population of at least 20% Medicaid patients can earn incentive payments based on their connectivity with other clinics and health offices. The federal government has authorized the state to spend up to $6 million for five years on this initiative.


Even within provider organizations that treat both mental illness and addictions, offering treatment on parallel tracks with two groups of clinicians will likely prove costly and ineffective. Integrated treatment delivered by clinicians who are cross-trained in both serious mental illness and substance use disorders has the strongest evidence base for improving patient outcomes. Giving these therapists all the tools they need for real-time decision-making when working with this high-need population is essential to the task.


A technology solution with extensive data collection and reporting capability will allow behavioral health providers to maximize care coordination for patients with co-occurring disorders. Sigmund Software’s AURA solution was developed with the behavioral health professional in mind. Its use can enhance provider efficiency, enable decision support, and facilitate productive interaction both within and outside the agency to coordinate care for vulnerable populations.


The data on co-occurring disorders has been compelling for so long that some might assume the industry has already figured out the challenge and moved on. But the gap between those needing treatment and those receiving it lingers, and the industry must do better in order to claim its rightful place in mainstream health care. Intelligent technology can help providers lead the hardest-to-reach patients to a promising future.




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