PCPA was pleased to attend a meeting on co-occurring addictive and mental disorders June 18 in the Washington DC area. Charles Curie, Administrator, Substance Abuse and Mental Health Services Administration (SAMHSA) announced his plan to explore adoption of a policy for using the Substance Abuse Prevention and Treatment Block Grant for the treatment of people who have co-occurring disorders. The ability to utilize the mental health block grant for co-occurring disorders currently exists. Click here for a copy of the announcment.
Curie also committed to working with the Centers for Medicare and Medicaid Services (CMS) to increase coverage for drug and alcohol treatment. In addition, he committed to working to remove the Institution for Mental Disease (IMD) exclusion, which prevents Medical Assistance from paying for non-hospital residential services. Mr. Curie addressed major concerns expressed by the D&A community about the fear of already scarce D&A dollars being evaporated by mental health expenses. He responded that "fire walls" will be put in to place to assure that does not happen. He also stated that parameters would be established for the use of the dollars.
This change will now make it much easier for there to be a "no wrong door" policy for serving persons with co-occurring disorders. They will be able to be treated appropriately in both the D&A and MH system. Curie also stated that the full continuum of illness would be included, not just the serious and persistent mental illnesses but also less serious co-occurring disorders.
Co-Occurring Report to Congress
Block Grant Policy Policy Under ConsiderationSAMHSA recognizes and respects the autonomy and uniqueness of the substance abuse and mental health treatment fields and the significant contributions they have made and will continue to make in the care of people with substance abuse and mental disorders.
Further, SAMHSA recognizes and respects the integrity of and the Congressional intent behind the Substance Abuse Treatment and Prevention (SAPT) Block Grant and the Community Mental Health Services (CMHS) Block Grant, and acknowledges that the SAPT Block Grant funds the major portion of substance abuse prevention and treatment in most States.
Further, SAMHSA recognizes and is committed to the importance of prevention and early interventions for individuals of all ages and understands its leadership role in ensuring availability and use of evidence-based prevention and early intervention programs.
However, SAMHSA also recognizes and acknowledges that a majority of individuals with co-occurring substance abuse and mental disorders receive inadequate or inappropriate treatment and are most likely to fall through the cracks of fragmented service systems. Those individuals who do receive treatment often receive care that is inadequate or inappropriate, in spite of the fact that these individuals are highly vulnerable to experiencing a host of negative outcomes that create an enormous burden, both for these individuals and for society. These include: more psychotic symptoms; greater depression and risk for suicide; violence; incarceration; inability to manage finances and daily needs; housing instability and homelessness; noncompliance with medications and other treatments; increased vulnerability to HN infection; lower satisfaction with family relationships; increased family burden; and higher service utilization and costs.
Based on the significant unmet need, as well as: a moral imperative to address this need; SAMHSA's commitment and responsibility, not only for people with the most serious disorders, but for all individuals with a co-occurring substance abuse and mental disorder; significant collaboration with SAMHSA's constituencies and mounting evidence-based and promising practices being applied by States and providers, Administrator Curie has directed SAMHSA to explore adoption of the following policy regarding use of the Substance Abuse Prevention and Treatment Block Grant for the treatment of people who have co-occurring disorders:
States that so choose may, as part of their Substance Abuse Prevention and Treatment (SAPT) Block Grant plans, include prevention, screening, assessment and integrated treatment models to address co-occurring substance abuse and mental disorders. States are encouraged to utilize all available/aggregated funds (including the Center for Mental Health and Substance Abuse Prevention and Treatment Block Grants and other Federal, State and local funding streams) to support integrated substance abuse and mental health services. States may use funds available to treat persons with co-occurring substance abuse and mental disorders as long as funds available are used for the purposes for which they were authorized by law and can be tracked for accounting purposes.
The States of Arizona, Connecticut, Missouri, New Mexico and Oregon already utilize the SAPT Block Grant funds for screening, clinical consultation and assessment. Connecticut, for example, uses these funds (about $200,000) to support counselors at three methadone programs responsible for screening of co-occurring disorders of all program referrals, clinical assessments, including psychiatric evaluations, and group counseling, including peer support.
SAMHSA will seek comments from the field on this policy concept requesting input on changes/clarifications through a notice of proposed rulemaking (NPRM) or a notice in the Federal Register.