Integrated co-occurring disorder treatment is an evidence-based practice that improves quality of life for people with co-occurring severe mental illness and substance use disorders by combining mental-health and substance-abuse services. While treating both conditions simultaneously is effective, rarely is it offered.
Studies show that approximately 50% of individuals with severe mental disorders are affected by substance abuse. At the same time, only 7.4% of people with co-occurring disorder receive treatment for both conditions and 55.8 % receive no treatment at all, according to the Substance Abuse and Mental Health Mental Health Services Administration. Clients often find themselves excluded from services in one system because of their comorbid disorder and told to return when the other problem is under control—a confusing challenge for clients trying to navigate the behavioral health system.
The Jerome Golden Center for Behavioral Health in West Palm Beach, FL is bringing change to what has been an under-funded and under-utilized approach. The center launched its co-occurring unit in 2015 and is currently the only evidence-based, licensed Level II Residential Treatment Facility in Palm Beach County for the adult underserved population. Eighty percent of Jerome Golden Center clients have incomes of $11,000 or less.
Treatment of co-occurring disorder has a significant impact on the individuals treated, and on avoiding the costs incurred for these patients who might otherwise be sent to a state mental hospital or jail. Annually as many as 125,000 people with a mental illness requiring treatment are arrested and booked into Florida jails.
The center’s program is a voluntary short-term (30- to 90-day) structured living environment with 16-bed capability, but funding provides support for only 12 beds through the fall. The center is currently seeking funding to continue its program in the coming year.
Best-practice, evidence-based components comprise the program, which are consistent with the center’s mission to help clients build resiliency, facilitate recovery and achieve reintegration into the community. Every client develops individual treatment plan objectives, including a commitment to complete 90 AA/NA meetings in 90 days. Trusting relationships are established by securing and maintaining sponsors throughout a client’s treatment and through working with case managers who provide support during residential treatment and after graduation.
While in the residential program, individual and interactive group activities, including life skills groups and meditation or creative arts, promote spirituality, wellness and support reintegration into the community. Clients are assisted with after-care planning for housing, employment and supportive services, and work with the clinical team collaboratively to address treatment objectives as well as proper discharge planning. Following program graduation, most clients continue to access services at the center and retain their relationships with their case managers who support their ongoing recovery and assist with other services such as housing and employment as needed.
This approach has been very effective. During the center’s 2017 fiscal year, the center’s 12 beds were consistently full, and 72 clients were treated. 100% of clients were discharged to stable housing, and none were arrested, convicted or incarcerated in the 180 days following discharge, nor were they hospitalized in a psychiatric unit. Services to support their reintegration in the community helped clients secure employment and register for important social services such as food stamps. By diverting mentally ill patients from jail and hospitalizations, the center created $740,000 in state and local savings.
“While the center’s co-occurring program has proven its effectiveness, funding challenges remain,” said Dr. Linda De Piano, CEO of the Jerome Golden Center. “It is an underfunded treatment constantly in need of support to change—and save—lives.”
Clients have shared their belief in the program, including one named Chad: “It was very rough dealing with depression and addiction most of my adult life. The Jerome Golden Center was there for me when I had nowhere else to go and accepted me without having insurance or any financial contribution. If it wasn’t for them, I wouldn’t be alive today or celebrating eight months clean on July 3, 2018.”
