SECTION IV: Recommendations Conclusion

The human and economic toll of co-occurring mental health and substance abuse disorders in this country demands immediate attention. The mental health and substance abuse systems must work together to address the barriers to care this population currently faces.
The conceptual framework identified in this report is an important first step. Among its unique characteristics, the framework encompasses the full range of people who have co-occurring mental health and substance abuse disorders, and it can be adopted or adapted for use in any service setting.
In addition, the framework suggests the level of service coordination ? defined as consultation, collaboration, or integration ? needed to improve consumer outcomes. These levels of coordination are specifically related to the severity of the disorders. Finally, it points to the need for special attention to two groups: 1) individuals, especially children and adolescents, who are at risk for developing more serious disease; and 2) people with severe mental health and substance abuse disorders who may be found in jails, in forensic hospitals, in emergency rooms, or living on the streets.
A comprehensive service system designed to address the needs of people with co- occurring disorders must have support at the highest levels. Further, it must be consumer- centered and feature a “no- wrong door” approach, i.e., services must be available and accessible no matter where and how an individual enters the system. The use of common data and assessment tools, staff who are trained in each other?s disciplines, and flexible funding mechanisms are also critical for success.
Each of the key players who participated in the meeting?the Federal agencies, national associations, and State directors ? has an important role to play in system change. Meeting participants encouraged SAMHSA to collect and disseminate best practice models; recommended that the States develop specific mechanisms to encourage, allow, and fund the collective efforts required to address the needs of this population; and urged NASMHPD and NASADAD to make co- occurring disorders a priority for each group separately and for both organizations together.
The time to begin this process is now. Meeting participants pledged to continue the work they began together and to involve all relevant stakeholders, including mental health and substance abuse providers and consumers and their families, in ongoing efforts to improve health outcomes for people with co- occurring disorders. In particular, NASMHPD and NASADAD made a commitment to present the group?s conceptual framework and recommendations to both their leadership and their members and to obtain support for future activities designed to move this cooperative effort forward.
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