Are the needs of people with co-occurring disorders being met?

In brief

People with co-occuring disorder (CD) have both substance use and mental health problems. These individuals often face more complex issues related to their illness and in accessing care from the mental health system. Researchers studied people with and without CD to find out if these groups needed different mental health services and used these services differently. The study enrolled 5,051 people with a severe and persistent mental illness who were participants in a community-based mental health program in Ontario.

EENet is pleased to feature a Research Snapshot on the article, “Need and use of services by persons with co-occurring substance use and mental disorders within a community mental health system,” by Christopher J. Koegl and Brian Rush, was published in Mental Health and Substance Use, vol. 5, no. 1.

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

Read it below or download the PDF.

What you need to know

People with co-occurring mental health and substance abuse problems need substance abuse, crisis, housing, and financial supports but are not getting enough of them from the community mental health system.  Further, their overall level of care is not meeting their level of need for more intensive programming.

What is this research about?

A co-occuring disorder (CD) is when someone has both substance use and mental health problems. A person with CD often faces more complex issues related to their illness and in accessing to care from the mental health system. This study examined people with and without CD to determine whether there are differences between these groups and the type and amount of services needed.

What did the researchers do?

Researchers from Ontario assessed 5,051 people with a severe and persistent mental illness. The participants were aged 16 or more and enrolled in a community-based mental health program in Ontario.  Those with a CD were identified from assessment data and compared to non-CD people in terms of their need for, and use of, 19 specific services and supports.  In addition, the participants were compared to an overall “level of care” index, which ranges from intermittent care or self-management to specialized tertiary inpatient care.

What did the researchers find?

The researchers found that more people with CD needed the 19 services and supports than people without CD, particularly in the areas of substance abuse programming, crisis management, housing and financial support and criminal justice system related supports.  People with CD also had higher rates of unmet need, most notably in the areas of substance abuse programming, assessment and diagnosis, crisis intervention and psychotherapy and counseling. People with CD were also significantly more likely to be grossly underserved in terms of their overall level of care.

How can you use this research?

This study is relevant to administrators delivering mental health services because it highlights pervasive service gaps for people with CD. There may be a need for more comprehensive assessment and treatment planning for these cases. This could be accomplished, for example, by providing integrated services within individual mental health programs and/or greater collaboration among community-based service providers.

What are the potential limitations?

This study uses data collected from Ontario during 2002, so the system may have changed in the meantime. Future studies may consider replicating this study with more recent data.

About the researchers

Christopher J. Koegl is the Director of Research at the Ontario Correctional Institute, Ministry of Community Safety and Correctional Services and Senior Research Consultant to the Centre for Children Committing Offences at the Child Development Institute, Toronto, Ontario. christopher [dot] koegl [at] ontario [dot] ca; cjkoegl [at] gmail [dot] com
Brian R. Rush is a Senior Scientist and Co-Section Head of the Health Systems Research and Consulting Unit at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, and a professor in the Department of Psychiatry at University of Toronto (U of T), Toronto, Ontario.

This Research Snapshot is based on their article “Need and use of services by persons with co-occurring substance use and mental disorders within a community mental health system,” which was published in Mental Health and Substance Use, vol. 5, no. 1 (2012): 4-19.


Concurrent disorder, mental health needs, service use, system planning, level of care, community mental health

This Research Snapshot is based on an article that has been critically appraised for quality and susceptibility to bias.

Evidence Exchange Network has partnered with the Knowledge Mobilization Unit at York University to produce Research Snapshots in the field of mental health and addictions in Ontario.

This summary was written by Maia Miller.

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