April 22, 2013

The White Deer Run division of CRC Health Group and Lehigh County, Pennsylvania, last month opened a facility devoted to treating co-occurring mental illness and substance use disorders (SUDs). The Lehigh County Center for Recovery, in Bethlehem, is licensed by the state and will be an adult co-ed, inpatient, detoxification and rehabilitation program with a focus on dual diagnosis. The program, 10 years in the making, will have 31 beds and 7 detox beds. It’s one of the first in the nation, which is “remarkable given the unmet need,” said Barry McCaffrey, a member of the CRC advisory board.

The center opened last month and immediately filled up, McCaffrey told ADAW. “What we’ll see is a payoff to the county on reduced crime, reduced ER costs, reduced court costs,” said McCaffrey. The county isn’t paying for all of the treatment — 70 percent of the beds are reserved for county-paid patients. “We’re still going to have to string along private-pay,” said McCaffrey. But this gives the public sector an opportunity to look at results when co-occurring disorders are addressed.

“It’s a county investment, but the county will be utilizing the state,” said Jerry Rhodes, chief operating officer of CRC Health Group, adding that Pennsylvania has a “very progressive publicly funded system.”

The state has a special funding category for co-occurring patients that goes through the existing payment system, said Rhodes.

In Pennsylvania, no special credential is needed to treat people with co-occurring mental illness and substance use disorders. However, CRC says clinical staffers in the program have master’s degrees and are trained not only in addictions but in mental health issues as well. Staff gets extra training on serious mental illness, including schizophrenia and bipolar disorder. Some of the employees at Lehigh transferred from other CRC treatment programs in the state and some were new hires, said Rhodes.

From a policy perspective, said McCaffrey, it’s hard to believe that for almost 15 years treatment for mental health and addiction has been separated. “The constant funding struggle is dysfunctional,” he said. “Even in a methadone treatment program, we know people still have other issues.”

Once someone has a serious drug addiction, by the age of 30 that person also has mental health problems, said McCaffrey. “It’s almost impossible to separate,” he says. While the figure typically cited is 40 percent, McCaffrey says that more like 100 percent of people with addiction also have a mental illness. Federal estimates are that there are 9 million people with co-occurring disorders. Many of CRC’s inpatient substance abuse programs do have psychiatric services available.

Co-occurring services will be delivered based on the needs of each patient, said Rhodes. “There will be consulting psychiatric services available,” he said. Patients entering the dual-diagnosis treatment program will already have been through detoxification, and free of illicit drugs, he said.

“It’s a myth that you can’t diagnose psychiatric problems until after detox,” said Rhodes. “You have to rely on the expertise of your clinical team to evaluate individuals.” But this evaluation can be done even before the patient has been through detoxification. •