Substance Abuse & Mental Illness

In

Domestic & Sexual Violence

The Need
Although, very little has been done to document and address the needs of domestic violence survivors who also struggle with mental illness and/or substance abuse, there is a growing body of research and programs aimed at doing just that. Nationally, these issues are calling shelters and all relevant providers to be part of the solution.

During five regional meetings held in 2006, the Montana Coalition Against Domestic and Sexual Violence (MCADSV) member programs identified a critical need to improve services to these survivors.

The Montana Coalition Against Domestic & Sexual Violence (MCADSV) therefore applied and received a Doors of Hope grant focusing on the co-occurring issues of domestic violence, substance abuse and mental health.

The contact person is our new Substance Abuse & Mental Health Coordinator, Natalie Bolon. Please feel free to call her at 406-465-5991. Be assured you will be hearing from her!

Meth and Mental Illness
MCADSV members also cited a dramatic increase in the number of these survivors seeking services, due in part to the state's growing methamphetamine problem, a problem that is particularly pervasive in rural states.

Several of our member programs report that most of the domestic violence survivors seeking shelter are meth-addicted. This is especially true of the state's urban shelters, as well as those serving the seven Indian reservations in the state, where approximately 25% of the adult population is substance abusing or addicted (MT DPHHS 2001).

While expressing the desire to serve meth-addicted women seeking shelter, many shelters say they are not equipped to do so, citing concerns for the safety of other shelter residents. As a result, these survivors are frequently either denied services or provided with limited services (basic shelter in a hotel, for example, rather than the array of services available within the domestic violence program). When attempting to serve survivors with mental health or substance abuse issues, many shelter victims struggle with how to do so without compromising their right to child custody, among many other issues.

Montana's mental health and substance abuse service system is severely under-funded and fragmented. There are no inpatient psychiatric services in Helena for individuals undergoing a mental health crisis, and the city's domestic violence shelter is not equipped to serve survivors experiencing a mental health crisis. Typically, these individuals are transferred by law-enforcement in shackles to the state mental health institution an hour away, although a short stay in a community setting would be sufficient to address their crisis. As in most of the state, Helenans face long waiting periods before they can enter detox, inpatient or outpatient treatment for substance abuse. The state only has a handful of inpatient beds where women can receive treatment while residing with their children. Thus most women who want to address their substance abuse are forced to leave their children, jobs and lives behind to do so.

The state recently formed regional service area authorities (SAAs) where individuals living with a mental illness, their families, state legislators, service providers and others are coming together to address regional needs. Local needs are addressed by Local Advisory Councils (LACs) focused on mental health service needs in their area. Currently, violence is not represented at these meetings¦ MCADSV is encouraging all members to attend their LAC and Regional SAA meetings. Contact Natalie for an initial introduction to these resources. You may be hearing from her inviting you to go with her, please make every effort to do so.

The state received a three-year grant from US HHS in 2005 to improve services to individuals addicted to meth, and 50% of those served must be women. The state legislature allocated funds in 2005 to improve local mental health crisis services, and many communities, including Helena, are actively developing new policies and programs.

These developments present an opportunity to engage in systems change, creating policies and practices at the state and local levels that are innovative and improve services to domestic violence survivors. Leadership at the National level is available from SAMHSA.

SAMHSA Recommendations
These goals are closely linked to the following Substance Abuse and Mental Health Services Administration (SAMHSA) recommendations:

• Consistent screening for co-occurring mental health and substance abuse problems, and histories of trauma at all portals of entry into the system
• Adequate outreach and follow-along care for women who may relapse, or who may go to jail, to insure continuity of care
• Build capacity of existing system to better serve women with these co-occurring problems
• Identify a network of care coordinators drawn from different agencies in each County
  
• Provide ongoing training of care coordinators in skills needed to provide services to women with co-occurring disorders and histories of trauma.
• Care coordinators' responsibilities would be to:
  • Develop a comprehensive assessment in collaboration with a woman
  • Assist her in developing an individualized recovery plan
  • Identify a recovery team consisting of friends and family, as well as service providers, based upon women's recovery plans and goals
  • Provide and coordinate services for the woman including linkages with basic needs providers and services for her children, as well as services for mental health, substance abuse, and trauma-related problem
• Embrace the principles of a recovery-oriented system of service delivery, including:
  • A commitment to the notion that recovery is possible for every woman served
  • A commitment to the principle that consumers are welcomed as partners in their care, which means:
    • Women are treated with respect
    • Women assume a significant degree of control in the development of their treatment plans, and in determining the goals toward which they choose to work
    • Women are provided with sufficient information about treatment alternatives for their problems, which include and embrace a range of "non-traditional" services and support
    • Women have more control over choosing services that are right for them

Project Goals
The main goals of the MCADSV Doors of Hope project are that:

• Local domestic violence programs will have the knowledge, skills and resources to improve services to domestic violence survivors with co-occurring substance abuse and/or mental health issues, and their children.
  

• MCADSV staff and member programs will participate in policy and program development collaborations at the state and local levels and ensure that the state's substance abuse and mental health service delivery system improves services to domestic violence survivors and their children.

Project Activities
After intense research, discussions with experts and input from our members, we plan to create training modules for DSV Shelter Staff and Victim Witness Advocates on Substance Abuse & Mental Illness such that they improve their basic knowledge, enhance their skills to successfully interact with addicts and the mentally ill, and have samples of policies, procedures and protocols necessary to effectively serve this population. We want any door they come in, to be the right door to get them help (and hopefully into treatment). The project will conduct activities such as:

1) Research to provide resources and technical assistance on these issues (from basic SA & MI knowledge to policies, procedures, protocols, communication tools, appropriate in-take and resource forms, etc.),
2) Assessment of the issues, needs and knowledge of our members regarding Mental Health and Substance Abuse via personal interviews and a survey,
3) Develop a variety of trainings to help DSV Providers, Advocates, Responders and Criminal Justice employees better understand and serve clients with mental illness and/or substance abuse, including the various legalities of such,
4) We will also provide DSV information, technical assistance and training to Mental Health and Substance Abuse providers to help them better understand and serve victims of violence via Trauma-Informed Care, and
5) Develop appropriate policy, protocols and programs, including legislative analysis, input and implementation across all three areas (Substance Abuse (SA), Mental Health (MH) & DSV).

A member survey is critical to identify barriers faced by the domestic violence programs in providing adequate services to violence victims, with a focus on the special needs of women with substance use and/or mental health problems. This information will be useful in providing an empirical foundation on which to develop and implement needed training programs for domestic violence program service providers and others who collaborate with these programs to meet the needs of Montana domestic violence victims. In addition, the survey will provide evidence concerning the importance of allocating adequate resources to these programs to assure that they are able to address the many and diverse needs of their clients.

If you have examples of any of the above that would be helpful for our shelters to better serve these victims, we would really appreciate your input! If you know of anyone else we should be contacting regarding these issues, please let the Substance Abuse and Mental Health Coordinator know.

We are grateful for any help you can give as re-creating the wheel has never made sense, only building on it!

THANK YOU FOR BEING PART OF THE SOLUTION!