Second opinion: bridging the gap between mental health care and addiction treatment

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My son Aaron was 19 years old when he died. His death certificate states that the cause of death was asphyxiation. The real cause was meth addiction and mental illness.

Aaron had more than that, just as there are as many as him. As a California Health Care Foundation’s new report showsAlso, there is much more we could do to help people living with both mental illness and addictions.

It’s not just a California problem or an American challenge. Far too many people around the world have suffered because they were treated primarily for a diagnosis rather than their related illnesses. Integrated care is difficult to achieve, but some states – including California – are pursuing promising approaches.

My son’s needs and struggles were not unique. Like many teenagers, he was sad and looking for a place to belong, especially when the divorce broke our family up. He tried marijuana and said it made him feel better. Then, when he was 14, someone gave him meth.

My husband and I started using Aaron psychiatric treatment and followed up with drug use treatment. But when he started biking through therapeutic programs, juvenile justice, and the district psychiatric hospital, it became clear that he needed a lot more. In the last two years of his life, as depression turned into meth-induced psychosis, he turned into one of the many lost souls seen in homeless camps. A person who fights with more than one demon.

It was then that we encountered a deadly paradox at the heart of many health systems. Providers were willing to treat Aaron’s psychosis or his chemical addiction – but it became a mad struggle to get them to treat both. Psychiatrists only treated his anxiety and psychosis; Drug treatment facilities refused to give him psychiatric medication. Coordination was in short supply. We could see he needed holistic care, but how?

A week before his death, Aaron was transferred from prison to a mental health facility to see a psychiatrist and have his medication recalibrated. He arrived without medication after the psychiatrist left for the day. He disappeared within the first 24 hours. A week later, on July 25, 2018, he was found dead near Highway 580 West in Richmond, California. He hanged himself.

Have at least 8.9 million American adults – including 500,000 Californians both mental illness and substance use disorders. Yet millions are left untreated because of the structural separation between mental health and addiction services – each with their own professional training, data systems, and privacy policies – that make coordinated, effective care difficult.

Only 1 in 13 people substance use disorder and mental illness are treated for both disorders. My family had health insurance and the financial means to help our son. But still we came across brick walls.

The new California Health Care Foundation study sheds light on the stories of Californians without the same resources that describe this struggle – one that often begins when patients first seek treatment and providers make a “primary diagnosis,” almost always is either a mental illness or an addiction, but rarely both. This initial assessment not only determines where people enter the health system, but also how they identify themselves – putting them at a terrible risk of completely inadequate care.

We saw this firsthand with Aaron: when he was diagnosed with depression, he saw himself as someone with a mental illness, not a user. He was reluctant to be labeled an addict. He thought meth addicts were the scum of the earth even when he became one. Our fragmented health system consumed precious time in this desperate battle, and time was short for Aaron.

It doesn’t have to be like that. For many people facing these challenges, truly coordinated care – across mental health, substance use and physical health systems – is required. can bring real healing. In fact, this is possibly the most successful treatment there is: a care that actively treats the “whole person”, bringing all health care providers together and linking them to other supports such as housing and transitions from inpatient treatment or incarceration.

The coexistence of substance use disorders and mental illness is a challenge not only here in the United States. the European Monitoring Center for Drugs and Drug Addiction names the association of substance use disorders with severe mental illnesses as a “key issue of national and international drug policy” and points out both the necessity and the difficulty of diagnosing and treating both illnesses at the same time.

Some states are working on a solution by incorporating types of care into their Medicaid programs. From 2016 to 2020, Washington State transformed its Medicaid physical health, mental health, and substance use disorder services into an integrated system. Early data show significant improvements in access to health care for people with co-occurring mental illnesses and substance use disorders. California leaders are pushing Medi-Cal, the state’s Medicaid system, in this direction bring a more integrated care into the program. An understanding that breaks down silos is also important: UCLA Medical School now requires psychiatry students to complete their education at a local addiction treatment center.

There is more that nations and states should do, such as simplifying the way care is paid for and helping families navigate these complex systems. We also need to call for real accountability, as well as training and technical assistance, to ensure that local health and social service providers work together.

So many lives can be saved. So many families stayed whole. We can help people like Aaron, and we have to.

Katherine Haynes is a Senior Program Officer at the California Health Care Foundation. She gave the foundation report “In their own words: How fragmented care harms people with mental illness and substance use disorder. “


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