Adults with Behavioral Health Needs under Correctional Supervision
The problems with multisystem integration are not unique to criminal justice and behavioral health collaborations. Even within the behavioral health arena, distinct systems have struggled to develop frameworks for collaborative service delivery. Although the treatment interventions for substance abuse and mental health conditions have far more in common than not, these fields historically worked in isolation from one another. There sometimes has been a “punting� of patients between the systems that reflects a failure to build on complementary treatment goals. Research has demonstrated that without concurrent attention to both sets of behavioral health issues, outcomes for individuals with co-occurring disorders are poor.103 It is also clear that not all individuals with co-occurring disorders are alike in the severity of either their addictive disorder or mental illness. These differences are critical in deciding the appropriate setting and level of care. In their landmark effort to create a unifying structure to address the needs of individuals with both mental illnesses and substance use disorders, the National Association of State Mental Health Program Directors and the National Association of State Alcohol and Drug Abuse Directors developed a model using mental illness and alcohol and other drug abuse severity dimensions (see figure 4).104
figure 4. Co-occurring Disorders by Severity High Severity
Alcohol and other drug abuse
30
III
IV
Less severe mental disorder/ more severe substance abuse disorder
More severe mental disorder/ more severe substance abuse disorder
I
II
Less severe mental disorder/ less severe substance abuse disorder
More severe mental disorder/ less severe substance abuse disorder
Low Severity
High Severity
Mental Illness
Reprinted with permission.