People who simultaneously suffer from mental health conditions and drug addiction face difficulties in Oregon finding providers who can treat both, a state study has found.
The OHSU-PSU School of Public Health study, commissioned by the Oregon Health Authority, determined that people with both conditions – called a co-occuring disorder – often have to surmount barriers to treatment, from long waits for care to a lack of providers that accept Medicare, which mostly covers seniors, or Medicaid, which covers low-income Oregonians.
The study — drawn from provider data — found that 82% of mental health providers and 40% of addiction treatment providers can treat people for co-occurring disorders. The study did not analyze the number of people in treatment or who are unable to access care, but noted that gaps exist throughout the system.
Beyond the study’s overall figures, it found differences among providers.
They include:
- Only half of mental health providers offer combined treatment for mental illness and addiction with the same clinician or treatment team.
- Treatment for both conditions is least likely in a hospital or substance use residential treatment facility, which often serve those with more severe illness.
- Only about half of the treatment providers treat gambling disorders.
- Many practices don’t accept Medicare or Medicaid, which could mean that patients can’t pay for treatment.
The study also found that workforce shortages are partly to blame for the lack of dual-trained professionals.
A provider’s perspective
One provider that offers both treatments in southwest Oregon is Adapt Integrated Healthcare. The nonprofit provides primary, mental health and addiction treatment in Douglas, Coos, Curry and Josephine counties. Its staff of about 600 people offer services that include counseling, medication-assisted treatment and primary care.
“We can coordinate with primary care and mental health and SUD,” said Tom Sorrells, chief of substance use disorder treatment at Adapt. “Those services can work together very easily under the same roof.”
At the same time, he said, it’s difficult to find a professional who is trained to treat both mental health and substance use disorders. A provider equipped to do both usually has a master’s degree – and those are among the hardest people to recruit because there are relatively few of them, he said. In comparison, certified alcohol and drug counselors – also a field in demand – don’t need a master’s degree.
“It’s not anything that we are struggling with to the degree that we have to restrict or limit services or access,” he said. “All of those remain robust and open for business. But it’s at the same time pretty clear that we are not at full capacity with our staff.”
Beyond staffing, he said, it’s also a challenge to reach people who need help.
“These are usually the most vulnerable,” he said. “Folks in our society, in the counties in which we work, they are hidden. They’re underserved. It’s very hard to even identify who it is that needs our help unless somehow they have the insight and resources to show up on our door.”
Some patients are referred through the criminal justice system or the Oregon Department of Human Services if they are a parent working to reunite with their children. But others are on their own.
“You just have a significant part of the population that’s unfortunately left unserved,” he said.
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