Winter 2003-04, Vol 7 No 2
You’ve been in a car accident. Your leg is badly broken and you are suffering from whiplash. The ambulance wouldn’t take you to one hospital for your leg and then drive you somewhere else for your neck injury. And it would be unheard of that your leg had to be treated and healed before receiving treatment for your neck. Yet, people with concurrent disorders – having both a mental health and addiction problem – commonly experience such an approach to treatment. They end up bouncing around the system and often receive duplication of services. Many become frustrated with a system that doesn’t identify the correlation between their mental health and addiction issues. But that’s changing.
A 1996 report by the former Addiction Research Foundation found that concurrent disorders were poorly identified across Ontario. Prevalence rates for concurrent disorders ranged between 20 and 80 per cent. In the Muskoka-Parry Sound region in north-eastern Ontario, the story was the same – many concurrent clients were falling through the cracks.
But forces in the region have joined to address this gap in service. Addiction Outreach Muskoka-Parry Sound and Muskoka-Parry Sound Community Mental Health Service formed a working group in 1999 to review treatment practices around concurrent disorders. In this rural area that spans nearly 24,000 kilometres, with a population of 99,000, Addiction Outreach and the Community Mental Health Service are the only agencies that provide addiction and mental health services. There is no mental health hospital, no residential addictions service and there are very few community services. Until recently, these two organizations operated independently of one another. It was a typical case of the left hand not knowing what the right hand was doing. But today, the two agencies are in sync.
“We can do more working together than we could working separately,” says Geoffrey Reekie, core program area manager for the Community Mental Health Service. The organizations have just put the finishing touches on their concurrent disorders program with staff training.
A collaborative program that identifies and treats people with concurrent disorders allows a single point of access for clients. “Consumers don’t have to retell their stories again and again,” Reekie says. A joint screening tool used by both agencies identifies candidates for the concurrent disorders program. The Community Mental Health Service now asks more questions related to addiction, and Addiction Outreach screens for mental illness. Those identified as candidates are directed to a concurrent disorders specialist (there are eight specialists in the region), who co-ordinates treatment between the two agencies. Added to this is a once-a-week consultation with Dr. Clive Chamberlain, a psychiatrist at the Concurrent Disorder Service at the Centre for Addiction and Mental Health in Toronto.
In autumn 2003, close to 40 clients were in the concurrent disorders program, including Darren*, a 47-year-old resident of Parry Sound who has bipolar disorder and an alcohol problem. Before joining the program, Darren had always been treated separately for his conditions. “I would be treated for my bipolar, and then I’d have to run somewhere else to be treated for addiction issues,” recalls Darren. But now, for the first time, he doesn’t feel like he’s battling his combined mental health and addiction issues alone. “Therapy is all well and good, but if you’re not meeting people who [also have concurrent disorders] you feel isolated,” he says. Darren meets other concurrent program clients in a psychoeducational group set up by the program. It provides education and some treatment interventions. And it provides clients with a sense of camaraderie and an opportunity to learn from other people with concurrent disorders.
But the change didn’t happen overnight, and it wasn’t without its challenges. Pat Walker, executive director of Addiction Outreach, says that the two organizations had different mandates, differing therapeutic approaches and different administrative styles. These differences had to be addressed, as well as issues of client confidentiality and other infrastructure hurdles, such as finances and human resources. But Walker says the positive feedback from consumers – one client told her, “It’s the first time someone has understood me” – shows it’s been well worth the effort.
Andrea Smith, an addiction services initiative caseworker for Ontario Work in the Parry Sound district, agrees. She has referred many clients to the concurrent disorders initiative. “Some individuals were in need of something different, which addressed their unique needs,” she says. “The concurrent group has filled a significant void for many of the people involved in our program.” And they are only getting started.
*not his real name