Advocating Positive Change

Vickie Harden, CMSW

As part of an initiative requested by the Tennessee Statewide Mental Health Planning Council and the Dual Diagnosis Recovery Network, providers, consumers and other stakeholders across the State of Tennessee came together for a series of meetings to address issues related to co-occurring disorders. Through this initiative, the Task Force on Co-occurrence was formed. Approximately 200 stakeholders met statewide through a series of forums on co-occurrence that involved over 140 hours of service time. Committed to identifying effective, low level and low cost, high impact solutions, the Task Force on Co-occurrence was represented by expert constituencies who defined The Next Step in Tennessee?s response to address co-occurrence. The composite expertise of the task force offered a comprehensive framework in defining state barriers to effective services and treatment, along with tangible recommendations for change to meaningfully impact this underserved and growing population.

The Task Force on Co-occurrence confirmed that Tennessee faces barriers to treatment consistent with that reported on a national level. Given the long-standing history of separate mental health and addictions approaches to treatment, effort must occur within each state to develop a common language and approach that unifies and integrates services for people who struggle with dual conditions. With existing initiatives throughout the country, decision-makers have committed to identifying obstacles to more accessible and appropriate services and develop policy and service strategies to better meet the needs of individuals with co-occurring conditions. Without intersystem communication and positive provider incentives to develop integrated systems, poor outcomes and a long-term increase in health care and other societal costs will continue.

Much like the recent congressional request that SAMHSA develop a joint task force on co-occurrence, the Task Force on Co-Occurrence recommended a legislative subcommittee and local level commitment to investigate and evaluate synergies to improve the state of co-occurrence services in Tennessee. Additional recommendations of the task force included:

Education/Awareness activities: such as university level curricula modifications to better equip professional staff to provide treatment for people with co-occurring conditions; public education and stigma reduction activities; implementation of prevention and education programs in elementary and middle schools; education of decision makers; promotion of activities to build synergies among mental health and addictions treatment providers; and resource development to increase access to appropriate co-occurrence services.

Policy recommendations: such as development of a liaison position to facilitate inter-departmental collaborations between the Department of Mental Health and Developmental Disabilities and the Department of Health, Bureau of Alcohol and Drug Abuse Services; review existing laws, regulations, and policies to enhance effective service delivery for people with co-occurring conditions; and implement criminal justice system enhancements such as training for key staff and officials and development of diversionary treatment services as an alternative to incarceration.

Provider capabilities: such as development of continuums of care that are consistent with outcome-based techniques to more effectively serve individuals with co-occurring conditions; implementation of statewide provider workshops to facilitate cross-training of mental health and alcohol and drug treatment staff.

Oversight: application of best practice standards statewide; required outcome measures and outcomes based treatment to increase provider accountability for effective treatment practices; and development of a stakeholder oversight body to monitor delivery of treatment and services for co-occurrence.

Research and Evaluation: enhance assessment measures to ensure that people with co-occurring disorders are effectively identified and appropriately treated.

The Task Force on Co-Occurrence compiled recommendations and findings in a report to be disseminated across Tennessee. The report will be presented to legislators, policy-makers and other stakeholders. Although the recommendations and findings of the task force are pivotal in moving this cause forward, task force members noted the importance of the synergy developed in the meeting process. Several of the work groups established for the task force plan to continue meeting to ensure the recommendations are acted on and that the report findings are available across the state.

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