I do believe that reversing the overdose epidemic does take a comprehensive approach as noted in the many examples put forth in the recent commentary "Reversing overdose epidemic" (Feb. 27). Unfortunately, it can't be comprehensive if the focus is only on substance use.
We continue to talk about mental health and substance abuse compartmentally when we know from national statistics that there are at least 70 percent of the people we serve with co-occurring disorders. It is the expectation, not the exception. The National Gains Center reports that prevalence rates of co-occurring disorders in the jail population are striking. With regard to the prevalence of substance use disorders among those with severe mental disorders, research indicates that both male and female detainees have a 72 percent rate of co-occurring substance use.
This paradigm shift should be making us re-evaluate our system, especially since more people are entering it due to the Medicaid expansion. It should be done by using common data elements to measure our service capacity and asking questions such as: Who is the population we are serving? What services are being provided and are they or aren't they appropriate (often only one of the two disorders is identified)? How much is this costing us and are the providers competent enough to provide quality treatment and using an integrated approach? Not until then will we be able to make informed decisions about how to put our money where it will make a difference.
Access to service is one thing, but if the service doesn't provide quality, is fragmented and not coordinated, it will create a service gap for all and consequently prevent consumers from reaching a higher level of wellness.
Patricia Bayly Miedusiewski, Monkton