Transcript Oklahoma Integrated Services Initiative (OISI).

The Oklahoma Integrated
Services Initiative (OISI).
and the
SAMSA, COSIG Project
Andrew Cherry
Endowed Professor of Mental Health
Project Evaluator
OU-Tulsa, School of Social Work
3-23-2005
COSIG SYNOPSIS
 On
October 5, 2004, The Oklahoma
Department of Mental Health and Substance
Abuse Services (ODMHSAS) was one of four
states to receive a five year Co-Occurring State
Incentive Grants (COSIG) from the Substance
Abuse and Mental Health Services
Administration (SAMHSA). There are 11
COSIG states participating in this incentive.
7/18/2015
COSIG Overview 3-23-5
The Oklahoma COSIG Project
 The
Oklahoma COSIG project will
seek to develop an integrated
system of care for persons with cooccurring disorders in State funded
mental health and substance abuse
treatment facilities that is accessible
to consumers and their families,
culturally competent, and grounded
in evidence-based practices.
7/18/2015
COSIG Overview 3-23-5
Two goals are proposed to guide
this project


Goal 1. Develop, implement and evaluate a
standard protocol for the screening and
assessment of mental health and substance
abuse treatment service recipients in all State
funded programs.
Goal 2. Develop, implement and evaluate an
integrated treatment model for persons with
co-occurring disorders that is accessible,
culturally competent, and grounded in
evidence-based (i.e., empirical-based and
consensus-based) practices.
7/18/2015
COSIG Overview 3-23-5
COSIG States:
Transforming the Way Our
Nation Addresses Cooccurring Disorders
7/18/2015
COSIG Overview 3-23-5
The Public Health Model
A community approach to preventing
and treating illnesses. Its premise is
that caring for the health of an
individual protects the community,
while—in turn—caring for the health
of a community protects the
individual—with society at large
reaping the overall rewards.
7/18/2015
COSIG Overview 3-23-5
Estimated Prevalence of
Co-occurring Disorders
 50%
of homeless adults with serious
mental illnesses have a co-occurring
substance abuse disorder
 16% of incarcerated individuals have
severe mental and substance abuse
disorders
 Among detainees with mental
disorders, 72% also have a cooccurring substance abuse disorder
7/18/2015
COSIG Overview 3-23-5
Mental Illnesses and
Substance Use Disorders
Percent of persons with mental illnesses
who also will develop a substance use
disorder
Persons
with
mental
illnesses
Co-occurring
disorder
7/18/2015
COSIG Overview 3-23-5
Up to
50%
Substance Use Disorders and
Mental Illnesses
20.4%
Adults with
mental
illnesses
Adults with
mental
illnesses
7%
All persons
Persons with a
substance use
disorder
Source: Serious Mental Illness and Its Co-Occurrence
With Substance Use Disorders, Substance Abuse and
Mental COSIG
Health
Services
Administration (2004).
7/18/2015
Overview
3-23-5
Substance Use among Adults
Aged 18 or Older, by SMI: 2003
Percent Using
60.0
53.2 53.9
50.0
44.2
40.0
27.3
30.0
20.0
28.9
25.2
23.5
12.5
10.0
0.0
Past Year Illicit
Drug Use
Past Month
Cigarette Use
Had Past Year SMI
7/18/2015
Past Month
Alcohol Use
Past Month Binge
Alcohol Use
Did Not Have Past Year SMI
COSIG Overview 3-23-5
Substance Dependence or Abuse among
Adults Aged 18 or Older, by SMI: 2003
Percent Dependent or Abusing in Past Year
25.0
21.3
20.0
17.0
15.0
10.0
5.0
8.6
6.7
7.9
2.0
0.0
Any Illicit Drug
Alcohol
Had Past Year SMI
7/18/2015
Alcohol or Any Illicit
Drug
Did Not Have Past Year SMI
COSIG Overview 3-23-5
Co-Occurrence of SMI and Substance Use
Disorders among Adults
Aged 18 or Older: 2003
4.2 million = 12%
15.2
Million
Substance
Use
Disorder
Only
15.4
Million
4.2
Million
Co-Occurring
Disorders
7/18/2015
COSIG Overview 3-23-5
SMI
Only
Past Year Treatment among Adults Aged 18 or
Older with Co-Occurring SMI and a Substance
Use Disorder: 2003
Treatment Only
for Mental Health
Problems
Treatment for Both
Mental Health and
Substance Use
Problems
39.8%
7.5%
3.7%
No Treatment
7/18/2015
49.0%
4.2 Million Adults with Co-Occurring SMI and
Substance Use Disorder
COSIG Overview 3-23-5
Substance Use
Treatment Only
People in Oklahoma with a
Co-occurring Disorder
If we estimate the number of people in
Oklahoma with co-occurring disorders,
based on national norms, the number
could be as high as 54,000 persons.
ODMHSAS data from the Integrated Client
Information System (ICIS) collected in
2003, found only 4,000 persons identified
as having a co-occurring disorder.
 This suggests a significant undercount
caused by a lack of recognition and
diagnostic skills among current
professional staff.

7/18/2015
COSIG Overview 3-23-5
Treatment and Services
in Oklahoma
While the number of people in Oklahoma
with a co-occurring disorder is still only an
estimate,
 The people with co-occurring disorders
who are not receiving the most effective
treatment are experiencing high
recidivism rates and numerous treatment
episodes.
 COSIG is designed to address this lack of
appropriate treatment and services.

7/18/2015
COSIG Overview 3-23-5
The overlap of three fields of study may be
the key to a better understanding of
mental health.






The same symptomology can come from any of at least
three disorders.
The key to understanding the etiology of mental illness,
substance abuse, and trauma will be found in the KEY,
the overlap between the three fields of study.
Mental Illness is an endogenous, physiological event.
Substance induced psychoses is an exogenous,
physiologically caused event derived from excessive
amounts of drugs that change the balance of the
endorphin type systems.
The psychosis that can follow trauma is a normal
response to abnormal circumstances. It is an
endogenous, physiological event caused by exogenous
events.
All three can produce the same symptoms in an
affected person.
7/18/2015
COSIG Overview 3-23-5
The same or similar symptomology
can come from
at least thee major sources



Mental Illness (MI) can result in a major
depression or psychosis.
Trauma can result in a major depression
or psychosis.
Substance Abuse (SA) can result in a
major depression or psychosis.
These among other conditions can produce
similar mental health related symptoms in
a person.
7/18/2015
COSIG Overview 3-23-5
All three conditions can produce similar
symptomology
in humans
MI
SA
The
symptomology
observed in the
person
7/18/2015
COSIG Overview 3-23-5
Trauma
A New Emerging Science:
The Study of the Co-occurring Disorders of
MH, SA & Trauma—Unlocking the Secret
Substance Abuse:
Addiction &
Compulsion
Mental
Heath
Trauma
7/18/2015
COSIG Overview 3-23-5
The KEY to
Understanding
Mental Disorders
Conclusion



This COSIG Project signals the beginning of a
process that is designed to integrate services
for people with co-occurring disorders into
the organizational structure of ODMHSAS.
The methods used in this process will
empower consumers and advocates.
Most importantly, it will result in the
development of a system of services that
is far more effective and available to
people with a co-occurring disorder than
ever before in State funded mental
health and substance abuse treatment
facilities in Oklahoma.
7/18/2015
COSIG Overview 3-23-5