Kelly A. Hunt

New York State Health Foundation: Integrating Mental Health and Substance Abuse Care

Roughly half of all people with severe mental disorders also have substance abuse problems. Yet their care is fragmented: They are treated by either the mental health system or the substance abuse system. In New York State only 10 percent of them receive evidence-based treatment for both conditions. Beginning in 2007 the New York State Health Foundation and two state agencies--the Office of Mental Health and the Office of Alcoholism and Substance Abuse Services--began collaborating on ways to integrate the treatment of people with co-occurring disorders. The state agencies removed financial and regulatory barriers to integrated treatment. The foundation provided funding to establish the Center for Excellence in Integrated Care. The centers goal: provide hands-on assistance in implementing best practices to at least half of the states 1,200 mental health and substance abuse treatment clinics. An evaluation found that the percentage of clinics using best practices doubled after the regulatory and financial changes and the centers intervention. This illustrates the potential that foundations, governments, and nonprofits, working collaboratively, have to improve the care of a neglected and difficult-to-serve population.

Medical vulnerability in America: how does the health system respond?

This study explores the hypothesis that market change affects the medically vulnerable more than the non-medically vulnerable. Analysis of data measuring change between 1997 and 1999 indicates that access to care eroded for both groups, but no evidence emerges to suggest that the changes were systematically worse for the medically vulnerable. Paradoxically, some measures of satisfaction with actual care received improved between 1997 and 1999 for both groups of people. Recent market changes do not seem to pose extra special threats to the medically vulnerable. However, our findings reinforce the need to better coordinate and integrate services for the medically vulnerable and chronically ill.