DRUG COURTS WORK TO BETTER ADDRESS CO-OCCURRING DISORDERS

On Thursday, A.J. Ernst, a Texas representative of the U.S. Department
of Health and Human Services Substance Abuse and Mental Health
Services Administration and specialist in co-occurring disorders, led
training at the Umatilla County Justice Center for local mental health
and substance abuse providers.

Friday's edition of the East Oregonian published a story about the
morning's training.

Thursday afternoon, representatives from Umatilla, Union and Malheur
County drug courts discussed how to better serve their clients when it
comes to co-occurring disorders; specifically mental health and
substance abuse disorders.

Ernst gave a simple example of why the two problems must be treated
simultaneously, not one after another. If a physician diagnosed Ernst
with hypertension and diabetes, then only treated diabetes, Ernst
would find a different physician. It's the same for co-occurring
disorders like substance abuse and mental health, he said. The
problems have to be treated together, or they're setting the clients
up for failure, Ernst said.

"Long ago are the days when substance abuse was just substance abuse,
and the same goes for mental health," he said. "Now, within the drug
court setting, you serve a population of co-occurring disorders. This
is really in the majority we serve."

Umatilla County drug court has a new position added at the beginning
of the year to screen all drug court clients for mental health
disorders. Prior to this position being created, mental health wasn't
addressed unless other treatment providers noticed a need.

In Union County, they said they are primarily focused on addiction and
recovery and they don't screen for mental health disorders at the same
time as substance abuse disorders.

In Malheur County, they've worked to make drug court a type of
one-stop-shop, where clients can get both disorders addressed. Ernst
said this is what is ideal, so clients don't have to fill out the same
paperwork or tell their life story over and over to different
providers. Also, this allows the providers to be on the same page in
constructing a recovery plan.

But, some providers from Malheur County contended, even though they
work to address both needs, the providers are separate in their
handling of the clients. For instance, each division - whether it be a
treatment counselor or a Lifeways provider - has an individual file
for each client, rather than all the divisions sharing one continuous
file.

A problem with sharing material is often what drug court coordinator
Christine Mosier-Crysler called "HIPPA-phobia," or a reluctance to
share information for fear of violating HIPPA rules.

Even in the cases where mental health and substance abuse are both
being treated, it's just as important the treatments work together,
Ernst said. Both providers need to be on the same team, deciding on
the right treatment plan specific for that individual. Sequential or
parallel approaches just don't work, Ernst said, because it doesn't
support long-term recovery.

"We're here for the long-term recovery," he said. "Short term doesn't
matter."

Ernst also recommended drug courts hire someone certified in both,
fulfilling that need in one person rather than two. In 30 of the 50
states, training is making its way from Connecticut, specifically on
co-occurring disorders.

"There's a tsunami coming across the country," Ernst
said.

If drug courts could cross-train one staff person, it would not only
free up another position, it would eliminate the parallel approach
taking place and changes it into an integrated one.

"There is an evolution to transfer the field into a holistic
approach," Ernst said.

It may also eliminate the stigma of "mental health." Umatilla County
drug court coordinator Roxann Fisk said she often encounters
resistance when approaching a client about mental health issues. They
may be completely willing to address their addictions recovery side,
but not accepting of the label of mental health disorders.

A new label co-occurring specialists are using now is "behavioral
health," Ernst said. This way clients can lose the negative stigma
they may see in either mental health or substance abuse disorders.

Funding was another big problem discussed Thursday afternoon. Both
Malheur and Union counties said they were not funded through public
funds, but instead supported by their communities and, in some cases,
by the participants themselves. This limits much of what they're able
to accomplish.

"Money will always be an issue," Ernst agreed. But, he cautioned the
groups against letting this become a roadblock. Rather, they should
focus on their strengths.

The three drug courts also decided to band together to search for
funding and discuss ways to improve their programs. The three
coordinators from each court agreed to work together to meet either in
one place physically or through teleconference. They also planned to
contact Wallowa and Baker counties to bring them to the table.