Adoption of Integrated Care for People with Co-Occurring Mental Health and Substance Use Disorders

Co-occurring mental health and substance use disorders (substance use disorders (SUDs)--known and referred to in this report as co-occurring disorders (CODs)--affect an estimated 6.6 percent of adults in the United States (SAMHSA 2021). Yet, people with CODs rarely receive both mental health and substance use treatment. For this study, Mathematica conducted a targeted environmental scan, interviewed key informants, prepared case studies of integrated care programs for people with COD, and analyzed national survey data. Overall, findings examined: (1) changes over time in the adoption of integrated care for COD in outpatient settings; (2) key components of integrated treatment programs; (3) factors that impede the adoption of integrated care; and (4) key opportunities to advance the adoption of integrated treatment. In 2020, we found that only about half of outpatient mental health and SUD facilities had a specific program for CODs; this finding reflected no change since 2014 for mental health facilities but a 10-percentage point increase for SUD facilities. Findings from the environmental scan and key informant interviews pointed to limited progress in widespread adoption of integrated treatment for people with CODs in the past decade, with advancements driven by motivated states and providers. Providers continue to encounter several barriers to providing integrated care for CODs, including lack of community and clinical data; separate regulatory, licensing, and reimbursement processes for mental health conditions and SUDs; significant financial investments and staff time required to implement integrated treatment; and limited workforce training related to CODs. Integrated care programs interviewed for the case studies overcame many of these barriers and shared some common components, including a comprehensive approach to screening, assessment, treatment planning, service delivery, and continuing care. Opportunities for addressing structural barriers to widespread adoption of integrated treatment include: (1) enhancing routine data collection and monitoring of CODs and integrated treatment; (2) streamlining state regulatory, licensing, and reimbursement processes; (3) expanding reimbursement, funding, and technical assistance mechanisms for integrated treatment for people with CODs; and (4) supporting formal and on-the-job training to equip behavioral health providers with skills to deliver integrated care.