for Integrating Mental Health and Addiction Services
Larry Davidson2007
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Abstract
Despite a range of long-standing historical, political, ideological, professional, structural, and practical barriers, there has been, and continues to be, a clear consensus that integration between mental health and addiction services is sorely needed and long overdue. This paper focuses on one dimension of the challenge of integration from among the several-the conceptual-and proposes the construct of recovery as an organizing principle for bridging the divide between the two domains. After reviewing briefly the parallel history of the two traditions and their shared need for transformation to a recovery orientation, the authors offer an integrated model of recovery for persons with co-occurring disorders. They then derive from this model the underlying values, guiding principles, key strategies, and essential ingredients of recovery-oriented systems of care which comprise a common approach across both addictions and mental illness, offering a strengths-based solution to achieving integration where pathology-focused approaches have failed. 1 "Treatment in parallel and separate mental health and substance abuse treatment systems . . . is remarkably ineffective" -Drake and colleagues 1, p. 361 This conclusion was drawn by Drake and colleagues from their recent review 1 of research on the care of individuals with co-occurring psychiatric and addictive disorders. While the conclusion itself is not surprising, it is striking that this conclusion continues to be just as salient today as it was when it was first reached over 25 years ago. Since that time, numerous reports, reviews, and research have documented well and extensively the uneasy relationship that exists between mental health services and services for persons with addictions. Consistent epidemiological and service utilization data collected during this same period have shown that mental illnesses and addictions co-occur within the same person as frequently as they exist independently of one another. These data further call into question the current bifurcation of the behavioral health field into two distinct and heavily bounded territories. While work such as the review by Drake and colleagues cited above has sought to overcome this split in the field by repeatedly highlighting the importance of providing integrated care for persons with co-occurring disorders, systemic efforts continue to lag behind and to encounter numerous obstacles. These obstacles range from historical, political, ideological, professional, and fiscal/structural issues at one end of the spectrum (e.g., separate funding streams, independent state agencies) to practical and logistical issues at the other end. And unfortunately, Ridgley, Goldman, and Willenbring's 14 discussion of these obstacles more than 15 years ago remains as relevant today as when first published. Despite these long-standing and formidable barriers, there has been, and continues to be, a clear consensus in the field that integration is both sorely needed and long overdue. This paper focuses on one dimension of this challenge from among those mentioned above: the conceptual dimension-and this for several reasons. First, previous efforts that have focused on the etiology or nature of mental illnesses and addictions, or on the types of treatments required by these conditions, have failed to establish a common ground adequate to provide a foundation for integration. Efforts aimed at resolving the political, fiscal, and structural issues that impede integration have had minimal impact thus far, perhaps in part due to their lack of a
