Health Professionals Experience Difficulty Treating Patients With Dual Mental Health Diagnoses

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The Washington Post tells the story of Danny Watt, who drowned in April 2008 after a lifelong struggle with mental health. Watt had a dual diagnosis: a serious mental illness along with abuse of drugs or alcohol.

"Danny Watt was a walking symbol of a phenomenon called co-occurring disorders, or dual diagnosis, which is estimated to affect 7 million adults in the United States. … About half of all adults who are seriously mentally ill are also thought to be addicted. The mental health community calls this 'self-medication.' The federal government estimates that 90 percent of people with co-occurring disorders do not get the treatment they need."

According to officials interviewed by the Post, "'He is responsible for his care, and he has decisions and choices to make,' said William H. Williams Jr., the agency's director of alcohol and drug services. 'When you look at the number of challenges that faced this particular case, I think we did an exceptional job in trying to resolve this young man's issues.'"

"But E. Fuller Torrey, a psychiatrist with the Treatment Advocacy Center in Arlington and a prominent critic of the widespread deinstitutionalization of psychiatric patients, says forced treatment is essential when people are too mentally ill to realize they need help. "Saying that Danny had responsibility for his care is 'fine for someone with substance abuse, but if you're dealing with psychosis, then there's no way you're going to treat someone like that in an unlocked facility,' Torrey said. 'What you're looking at is the system is not set up to treat the difficult patients'" (Jackman, 7/28).

In an accompanying piece, The Washington Post reports that sometimes 50 percent or more of mental health therapists' and substance abuse counselors' patients suffer from both mental illness and addiction to drugs or alcohol. And treatment facilities sometimes don't offer good enough observation to keep them from relapsing, they report: "At Cornerstones, Fairfax's 16-bed residential treatment facility for men and women, a college-dorm-like setting provides structure (meetings, meals, 'medication calls') and group activities but not heavy discipline. The doors are unlocked, and clients have the option of walking out. Stays can last as long as six months. Stores that sell alcohol are nearby. The residents are adults and must make their own choices. 'People relapse,' said Melissa Anderson, the center's director. 'But they come back the next day'" (Jackman, 7/28).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

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