Dual Diagnosis Services

Dual Diagnosis Project Summary
Historically, the State of Texas has provided mental health services for persons with severe and persistent mental illness through the Texas Department of Mental health Mental Retardation (TDMHMR) and the treatment services for persons with substance abuse/chemical dependence through the Texas Commission on Alcohol and Drug Abuse (TCADA). These services to the mentally ill and chemically dependent are provided in parallel, separate systems of care. TDMHMR and TCADA acknowledge that evidence now exists to support the philosophy that, models of care which integrate mental health and substance abuse treatment for persons with co-occurring mental illness and substance abuse disorders can succeed where our parallel, separate systems of care have historically failed.

Therefore, the 74^th Legislature, Pursuant to SCR 88, mandated that TDMHMR and TCADA cooperate in the design, implementation, and evaluation of Integrated Treatment. The pilot project will address the needs of the dually diagnosed population and identify the barriers that exist to accessing and receiving adequate services to effectively treat their disorders, identify costs in effectively treating this population, and develop strategies to overcome existing barriers. Emphasis will be placed on meeting the needs of the high percentage of individuals with co-occurring substance abuse/addiction and mental illness who are also frequent utilizers of intensive and/or crisis-based services, jails and prisons; the indigent; and individuals who evidence high rates of relapse and recidivism. Efforts will also be directed toward facilitating fundamental system changes to improve access to integrated systems of care.

The objectives of the pilot project are:

1. To identify, develop, and implement effective and efficient methods of engagement, assessment, and treatment models for persons with co-occurring substance abuse and mental illness disorders.
2. To create meaningful partnerships, particularly between public mental health and substance abuse systems, for the purpose of establishing more effective and efficient community-based treatment.
3. To identify and evaluate key program and partnership elements in successful programs so that these efforts can be replicated.
4. To incorporate the information gained through the project to enable the provision of integrated services throughout the state.

• Assertiveness - Assertive and flexible outreach to potential consumers/clients.
• Close Monitoring - Intensive supervision during the early phases of treatment.
• Integration - Mental health and chemical dependency providers render concurrent and coordinated services to the consumer/client.
• Comprehensiveness - Treatment interventions are modified for each individual dependent upon the client's/consumer's mental illness, phase of recovery, level of acuity, severity, disability, and motivation.
• Stable Living Situation - Secure safe, affordable, and drug free housing options.
• Flexibility and Specialization - Mental health and substance abuse professionals must modify their traditional beliefs, skills, approaches, and training.
• Stages of Treatment - Clinical strategies are modified dependent upon the consumer's/client's readiness for change.
• Longitudinal Perspective - Recovery occurs over years and relapse is a part of the recovery process.
• Optimism - Service providers must provide emotional support as the client/consumer overcomes the stigmas associated with both disorders.
• Client progress through treatment will be monitored according to the following Stages of Treatment:
• Pre-engagement - Service provider works toward establishing trust and rapport with potential client/consumer.
• Engagement - Consumer/client has irregular contact with service providers as trust and interest in services builds.
• Early Persuasion - Regular contact with service providers and discussion of reduction of non-prescribed drug use.
• Late Persuasion - Established relationship with service providers and actual reduction of non-prescribed drug use.
• Early Active Treatment - Continued reduction of non-prescribed drug use as client/consumer works toward abstinence.
• Late Active Treatment - No use (or controlled use without associated problems) for one to six months.
• Relapse Prevention - No use (or controlled use without associated problems) for at least six months.
• Recovery - No use of over one year and formal substance abuse treatment ceases.

Last Updated February 23, 2006