Barriers to Integrated Treatment

There are a number of barriers that need to be addressed to truly create integrated systems of care for people with co-occurring disorders. Some of these barriers include:

• Federal, state and local infrastructures that are generally organized to respond to single disorders
• No single point of responsibility exists for treatment and care coordination ****
• Mental health and substance abuse service systems often vie for the same limited resources
• The funding mechanisms for the two systems are often inflexible, difficult to navigate, and involve a myriad of state, federal and private sector payers with variable eligibility requirements and benefit offerings that do not encourage flexible, creative financing ****
• A lack of any significant connection between mental health and substance abuse provider and service programs*****
• A shortage of training opportunities, creating a situation whereby too few staff are trained in treating both mental and substance abuse disorders*****
• Differing treatment philosophies in the mental health and substance abuse treatment fields*****
• A reluctance by clinicians to address co-occurring disorders, particularly when one of the disorders is in an area in which the clinician is untrained*****
• Co-occurring disorders are prominent among chronically homeless people and other groups that are especially hard-to-serve ****
• Too little research-based guidance for the treatment of people with less severe co-occurring disorders*****

**** From the National Governor's Association on Best Practices

***** From SAMHSA's Strategies for Developing Treatment Programs for People with Co-Occurring Substance Abuse & Mental Health Disorders, (Adobe Acrobat PDF, 385 KB), Rockville, MD, 2003