Area agencies have been ramping up efforts to better address the co-occurrence of mental illness and substance abuse in response to the opioid epidemic in Northeast Pennsylvania.
This co-occurrence has long been recognized by mental health professionals, but the increasing opioid problem has brought the diagnosis to the forefront because “the combinations now are more deadly,” said Tara Vallet, administrator for Mental Health and Developmental Services for Luzerne and Wyoming counties.
“It certainly does impact our (mental health treatment) system,” Vallet said. “We’re working to increase the amount of treatment options where people can get treatment for both mental health and substance abuse at the same time.”
Understanding the connections between substance abuse and mental illness is essential, according to Dr. Leighton Huey, associate dean for behavioral health integration and community care transformation at Geisinger Commonwealth School of Medicine.
“There are many different patterns that occur when someone has a substance abuse disorder,” Huey said.
Sometimes substance abuse can trigger a mental illness, and other times, having a mental illness — for example, bipolar disorder, especially if it goes untreated — can lead someone to substance abuse and addiction, he explained.
Huey stressed that he’s not making a distinction between addiction and mental illness because substance abuse disorder is a psychiatric disorder.
The American Psychiatric Association defines addiction as a complex condition — a brain disease — that is manifested by compulsive substance use despite harmful consequence.
“People with addiction (severe substance use disorder) have an intense focus on using certain substances, such as alcohol or drugs, to the point that it takes over their life. … People with a substance use disorder have distorted thinking, behavior and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug,” according to the association website.
Recognizing problems, overcoming stigma
Huey said a major hurdle for people suffering with mental illness can just be having it diagnosed.
“The first line of defense is the family. But will a family recognize patterns of concern?” Huey asked. “It’s very difficult for a family to arrive at that conclusion unless what’s observed is so out-of-character that (mental illness) would be obvious.”
“In the school system, teachers are really important monitors of what’s going on. Does a student seem withdrawn, overly anxious? How is he or she engaging with other kids?” he said.
A stigma associated with mental illness often deters someone from seeking diagnosis and treatment and family members, teachers, friends or co-workers from encouraging an individual or a child’s family to seek help, Huey and Vallet agree.
Vallet said there have been more efforts over the last couple of years to increase awareness and education about mental illness to fight the stigma and “to educate the community so people know where they can turn for help.”
Vallet noted that her agency is administrative. The department contracts with approximately 25 mental health providers, and the three primary providers — Children’s Service Center, Northeast Counseling and Community Counseling Services — are licensed to treat co-occurring disorders.
“When we have trainings available, all of our providers are notified and invited to participate. There’s still a demand we’re not meeting, but we have ramped up that training availability,” she said.
Increasing education, training opportunities
Vallet’s department also partners with Family Services Association of Northeastern Pennsylvania to provide the public with education and awareness about mental health to help alleviate the stigma, teach people about symptoms and direct them to sources of help.
“Support services are available, and it’s as simple as dialing 211 — our local Help Line. And services are confidential,” she said.
Vallet’s department also partners with the Northeast Behavioral Health Care Consortium, a nonprofit that manages the HealthChoices behavioral health program for people on Medical Assistance in Luzerne, Lackawanna, Susquehanna and Wyoming counties.
The consortium has increased educational opportunities and programming on co-occurring diagnoses for providers in the four-county area as well, she said.
Vallet said her department is also working to train crisis workers to understand the connection between the opioid epidemic and mental health issues.
When someone tells a crisis worker that they or someone else has an opioid problem, “rather than saying, ‘oh, that’s not something we do,’ we need to be making sure they get to the right place to get the help they need,” Vallet said.
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