Mary Jane Alexander, Ph.D., Program Director

Individuals with severe mental disorders, by virtue of where they live - frequently in poor communities - are at high risk for exposure to adverse environmental threats to the general public health, such as addiction and violence. Because of their severe mental disorder, they are also particularly vulnerable to the consequences of exposure. Co-occurring disorders variously affect the course of their psychiatric disorders; the service systems they are likely to encounter and use; their ability to maintain the stability and social networks that allow them to cope with their illness, their families, and their own abilities to sustain adult social roles.

This research program utilizes epidemiologic and clinical health services research approaches to identify populations whose exposure to environmental threats complicates their interaction with the mental health service system. It is focused currently on the quality, efficiency and effectiveness of clinical services for two co-occurring disorders: severe mental illness and alcohol or drug problems, and severe mental illness and exposure to traumatic events. The interdisciplinary and policy focused research on co-occurring disorders is funded by awards from the National Institute of Mental Health (NIMH) and by the Center for the Study of Issues in Public Mental Health (CSIPMH).

A study to determine the utility of screens for both disorders, the MINI and the DALI, among the heterogeneous cultural groups who use services in a wide range of service settings across New York State has just been completed. The study used the Four Quadrant framework developed in New York State and adopted by SAMHSA to locate responsibility for addressing both disorders based on their severity. In conjunction with NYS OASAS Practice Improvement Collaborative, a pilot implementation of the mental health screen is underway in three clinical sites. This work has led to requests for technical assistance in developing screening programs for co-occurring disorders, e.g. among women in jails and in state systems of care. Through the NYS OMH Bureau of Community Forensics, we are introducing the screens to the NYS Department of Probation and Parole.

We are collaborating with the NYS OMH OASAS Interagency Workgroup on Co- occurring Disorders to study how a Dual Recovery Coordinator initiative, designed to integrate services and coordinate systems on the local level has affected local networks for people with co occurring disorders.

A rigorous field study of the treated prevalence and service use patterns of individuals with mental illness and chemical abuse problems has just been completed. Gender specific indicators of mental illness and chemical abuse problems will be developed based on the data from that study.

A range of projects focused on co-occurring illness and trauma exposure are being conducted in collaboration with recipients of services. A study has just been completed that examines the costs of untreated trauma among users of state hospital services in Maine. Based on a framework for healing from sexual abuse trauma developed by trauma survivors with severe mental illness, we have designed a draft measure of healing from trauma. This measure is currently being pilot tested in collaboration with traditional and consumer provider organizations.

Extensive collaboration has been facilitated with support from the CSIPMH. Gary Haugland, MA, and Mary Jane Alexander, Ph.D. have completed several mail surveys to assess the need for services for mental illness and chemical abuse problems across counties and providers in NYS. The Interstate Cooperative Work Group on Trauma is supported in part by the CSIPMH. The Workgroup includes Mary Jane Alexander, Ph.D., and Kris Jones, Ph.D. (NKI), Kristina Muenzenmaier, M.D. and Janet Chassman (NYS OMH), Andrea Blanch, Ph.D., Ann Jennings, Ph.D. and Ruth Ralph, Ph.D. (Maine DMHMRSAS). The group has evaluated the applicability of clinical programs for trauma survivors for individuals with severe mental illness who use public mental health services; has developed a survivor and provider based needs assessment; has developed a healing instrument for trauma survivors; and is participating in the development of a rigorous curriculum to train staff in public mental health settings to identify and address trauma related problems.

The expertise in statistical and health services methodologies, including cost analyses that resides at NKI supports this research program. Investigators at NKI have the capability for using qualitative methods (e.g. Life Charts, Concept Maps) as well as quantitative methods, for designing and implementing large field studies, and for manipulating large, public use data sets. Real life questions and policy focused results have been afforded by the collaborations between NKI investigators, service recipients and state policy makers.

For further information, contact Dr. Alexander at