It is ironic that the most vulnerable members of American society face the difficult, sometimes nearly impossible, task of dealing with multiple systems. People who are homeless, disabled, poor, or recently released from prison—among others—may have to contend with the acute medical care system, the disability system, various social service agencies and, in some cases, the criminal justice system.
One study by two Brown University researchers found that there were 127 agencies serving the disabled in the medium-sized community of Springfield, Massachusetts.
The fragmentation of services is a particularly severe problem for people with both mental illnesses and addiction to drugs or alcohol, who are often shuttled between mental health and substance abuse systems, receiving unsatisfactory services from both.
In this chapter, Paul Brodeur, an award-winning journalist and former staff writer for The New Yorker, discusses an approach to organizing services for people with both substance abuse addiction and mental illness. The large number of people who suffer from co-occurring mental illness and substance addiction is not widely appreciated, even though it affects about 3 percent of the adult population of the United States. Looked at from a different perspective, approximately half of the people with severe mental illnesses also have a substance abuse problem. Individuals with an existing mental illness consume roughly 38 percent of all alcohol, 44 percent of all cocaine, and 40 percent of all cigarettes in the United States, and those who have ever experienced a mental illness consume about 69 percent of all the alcohol, 84 percent of all the cocaine, and 68 percent of all cigarettes.
Developed under a grant from the Local Initiative Funding Partners program, a collaboration between the Robert Wood Johnson Foundation and local foundations to support innovative and worthy local projects, the Community Mental Health and Substance Abuse Partnership of Larimer County, Colo., has established a coalition of public agencies and private organizations to coordinate services for people with these co-occurring conditions.
Repairing the fragmented system of delivering health care services has been a longstanding concern of the Robert Wood Johnson Foundation. The On Loc and PACE (Program of All-Inclusive Care for the Elderly) initiatives integrated acute and long-term care for frail elders by providing social and medical services in an adult day care setting. The Community Partnerships for Older Adults program was designed to coordinate long-term care and social services for elderly people. In the mental health arena, the Mental Health Services Program for Youth and the Program on Chronic Mental Illness both attempted to develop ways to coordinate mental health services in the community.