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Concurrent Disorders SWRK 2083 Wk 2 History & Context: Concurrent Disorders in Canada

Concurrent Disorders SWRK 2083 Wk 2 History & Context: Concurrent Disorders in Canada. Keith Cameron, M.A., M.B.A. Review Key Concepts. What is a Concurrent Disorder? Having one raises risk of having the other Mood and/or anxiety plus alcohol most common Double Stigma Two treatment streams

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Concurrent Disorders SWRK 2083 Wk 2 History & Context: Concurrent Disorders in Canada

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  1. Concurrent DisordersSWRK 2083Wk 2History & Context: Concurrent Disorders in Canada Keith Cameron, M.A., M.B.A.

  2. Review Key Concepts • What is a Concurrent Disorder? • Having one raises risk of having the other • Mood and/or anxiety plus alcohol most common • Double Stigma • Two treatment streams • Assessment tricky • Clients more likely to seek treatment, more likely to quit

  3. Service Delivery: Pre – 1960s • Historically, 3 clinical populations: • ‘mental patients’: treated in psych facilities • ‘alcoholics’: only ‘chronics’ treated, in specialized facilities • ‘drug addicts’: seen as very small segment of society, largely criminal: legacy of moralistic view

  4. Changes caused by… • Deinstitutionalization/closing of psychiatric hospitals…led to RTE Program at GBC • Community support model • Wide availability of recreational drugs since 60s…led to Human Service Counselor Program at GBC, predecessor to SSW

  5. Clinical Populations: no longer separate Now have large groups of people with overlapping & interacting mental health & substance use problems Problem: policy, funding, education, service delivery stuck in ‘single problem’ mode: either mental health or substance abuse One clinical population?

  6. W. Skinner article: Guest Editorial • Workers, especially social workers, have holistic values: • We want to consider the whole person • Use Bio-Psycho-Social Model • But systems for treatment are not integrated, not holistic • So we end up treating part of the person only

  7. Skinner Article… • Specialization improves ‘evidence-based’ practice…but leads to exclusion of clients from specific services • Research on m. health excludes clients with s. abuse & vice versa • Specialization leads to exclusion of complex clients • We don’t have the knowledge base to work well with C.D. clients

  8. Conflicting Treatment Philosophies • Does harm-reduction always complement treatment for mental health? • I.e. small amounts of cannabis safe for those with psychosis • Does AA Model complement m. health treatment?

  9. Service in one setting: no division of m.health & s. abuse services Reconcile different treatment approaches Can we be open to client’s choice: harm reduction, abstinence, disease model, cultural views…? Overlapping/Integrated Treatment

  10. Differences…

  11. Parallels Between MH & Substance Abuse • Biological, psychological & spiritual contributing factors • Long-term condition that can be disabling • Leads to lack of control over behaviour & emotions • Affects the whole family • Responds to treatment?? • Often viewed as a personal weakness • Person experiences guilt, shame, failure & stigma

  12. How Does Each Problem Affect the Other? Mental health & substance use problems can affect each other in several ways: • Substance use can make MH problems worse • Substance use cam mimic or hide the symptoms of mental health • Sometimes people turn to substance abuse to “relieve” or forget about the symptoms of MH problems

  13. Social Work Role • Holistic philosophy • Both groups have serious ‘psychosocial’ problems, including family issues • Group work helps both groups • Building relationships within treatment centres and in the community…we treat ‘person in the environment’

  14. Continuum of Care To provide mental health services to the seriously mentally ill that facilitates their ongoing functioning in the community, avoiding hospitalization where clinically possible. Mobile Crisis ACTT Short Term CM Manse Road Outpatient Adult/Child Inpatient Beds Day Clinic Justice CM Intensive CM MCIT POP

  15. Model for Appropriate Treatment

  16. Terms…. • Consultation: Informal links between services • Collaborative Care Formal links for clients with one mild disorder, one serious disorder • Integration: Substance Use and Mental Health Treatment in one setting i.e. CAMH

  17. Severity: how do we decide? S. Abuse Amount consumed each time (Alcohol: CAMH Guidelines?) Type of substance One or more? How often? Impact on Functioning Priority activity? M. Health Intensity Duration Level of distress Impact on Functioning Self-Medicating? Able to self-advocate? Insight?

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