The treatment of persons with dual diagnoses in a rural community

Abstract

Persons with dual diagnoses of psychiatric illness and substance abuse represent a large subpopulation within the mental health system, but mental health service delivery systems typically do not adequately address their special needs. The literature on dual diagnoses is marked by the paucity of information on such persons in rural settings. This paper describes the characteristics of a rural community mental health system, which illustrate the difficulties in treating persons with dual diagnoses in rural communities. These problems include a fragmented system of services, centralized services in a large geographic area, overly restrictive regulations, conceptual differences in treatment approaches, confidentiality and stigma in a rural culture, and the academic and professional isolation of mental health workers, leading to high turnover and a shortage of staff having sufficient training and experience to work with persons with dual diagnoses. Some recommendations to address these problems and to improve the delivery of services to persons with dual diagnoses are suggested.

Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionals

“…The treatment of dual diagnosis clients in rural areas has been reported in the literature as being complex. Howland (1995, p. 33) identified the following difficulties in treating people with a dual diagnosis in rural areas as ‘a fragmented system of services, centralised services in a large geographic area, overly restrictive regulations, conceptual differences in treatment approaches, confidentiality and stigma in rural culture, and the academic and professional isolation of mental health workers . .…”

The Importance of Social Support for Rural Mental Health

“…Historically, rural residents have preferred first and second tier supports, versus formal supports (Lee, 1998). This reluctance to accept formal service may be due to stigmatization, as well as the difficulties in maintaining confidentiality in rural communities (Howland, 1995). A further challenge for those with mental illness may be reluctance to accept social support from families and friends for fear they may learn of their mental health problems.…”

Self-Reported Psychiatric Treatment Needs Among Felony Drug Offenders

“…Despite these high estimates of dual diagnosis, treatment for such individuals, in and out of the criminal justice system, has remained fragmented, with few service delivery systems adequately addressing their special needs (e.g., Hoff & Rosenheck, 1999;Howland, 1995;Wallen & Weiner, 1989). Some researchers note the increased total cost of treating dual diagnosis patients is primarily associated with increased utilization of outpatient psychiatric and substance abuse services (Hoff & Rosenheck, 1999); the increased cost may simply reflect the greater severity of illness among dually diagnosed patients.…”