Mail Surveys to Community Service Directors 
Regarding Mental Illness and Chemical Abuse 

(Integrating Services for Persons with Co-occurring Disorders)
Updated July 2001

Principal Investigator: : Mary Jane Alexander, Ph.D , Co-PI: Gary Haugland, M.A. 

A survey was conducted across New York State to determine how services are provided for persons with dual diagnoses of mental illness and chemical abuse (MICA). Differences in program models between urban and rural settings were noted, and unmet service needs highlighted.

PROJECT GOALS
Through a survey  of community service directors and service providers conducted by mail, the goals of this project were to:

• describe the varied ways counties in New York State provide services to persons with co-occurring mental illness and chemical abuse (MICA), 
• explore to what extent the service needs of persons with MICA are perceived as being met across different areas of the state, 
• provide a sampling frame for a site study of dual diagnoses.
• document local barriers to integrating services for PSMD with co-occurring chemical dependency problems through a survey with  NYS county mental health directors, and 
• describe successful local strategies for integrating services

RESEARCH ACTIVITIES AND RESULTS
Method: Community service directors in 49 counties in New York State responded to the survey. Seventy-one percent of the respondents represented 35 primarily rural counties and accounted for 30% of the population represented in the survey. The mail survey was completed as of September 1, 1995. The data were analyzed to disclose rural/urban differences and the results presented as posters at two research conferences.

Findings: On the basis of the responses of community service directors, the results indicate the following:

• (1) Persons with coexisting psychiatric and substance use disorders presented serious problems in a majority of urban and rural county service systems.
• (2) Formal linkages between the mental health, alcohol and drug treatment systems existed in only about half of the counties, with no rural/urban differences.
• (3) Rural area service systems were more likely to follow community-based models, while urban area systems tended to be hospital-based.
• (4) Rural areas did not have as many services available, especially specialized MICA units in hospitals and MICA outpatient groups.
• (5) Urban areas expressed a greater need for community residences and residence-based substance abuse services. Urban counties also indicated that homelessness was a more serious problem.
• (6) Rural areas were less likely to have demonstration projects and staff training opportunities for addressing MICA problems.

The survey has provided the sampling frame for the site study of dual diagnoses being conducted within the Center.

INCLUSION OF GENDER AND MINORITY SUBJECTS
This mail survey of community service directors regarding their counties' mental health and substance abuse service systems did not make provision for exploring gender or minority differences. No subjects per se were part of the study; the county was the unit of analysis and the respondent was the person from that county designated as the director of community services. It was not believed that the gender or ethnicity of each director was relevant to the responses offered, and the number of respondents (n = 49) was far too small to detect significant differences. As far as inquiring about the gender and minority of individuals served in these counties, we determined that it was probably beyond the ability of the informants to provide accurate information and that a field study would be required. Therefore, no specific questions were asked regarding gender and minority characteristics of those in the county treatment systems.

SIGNIFICANCE OF FINDINGS/POLICY IMPLICATIONS
Some of the significant findings and policy implications include the following:

• (1) Formal linkages among the various treatment systems need to be established in all counties.
• (2) Rural areas need to be targeted for more demonstration projects and staff development.
• (3) Rural areas need more flexible and informal components of their service systems, such as mobile outreach, self-help groups, and drop-in centers.
• (4) Urban areas must deal with residential instability in this population and thus need more community residences for those with mental illness as well as residential treatment options for drug and alcohol abuse.

This project reflects active and ongoing participation of the Center in the work of the NYS Conference of Local Mental Hygiene Directors and the NYS OMH/Office of Alcohol and Substance Abuse Services (OASAS) Interagency Workgroup on Dual Disorders.  Localities have used findings to train staff in best practices and promising models for co-occurring disorders.  The Interagency Workgroup has used the results to identify both factors that impede the delivery of integrated services, as well as  local strategies that are successful.  

PLANS:                 As the State moves ahead with SAMHSA in plans to relax restrictions on blended funding streams for mental health and chemical dependency services, the Center will revisit the local strategies that were described in this project as successful in integrating services, in order to evaluate the impact of fiscal and regulatory changes on service delivery.

PRESENTATION: Results of this completed project were presented at the 2000 American Public Health Association Meeting and the 2001 Conference of the National Association of State Mental Health Program Directors.

Project Completed.

Updated: July 9, 2001 

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