Draft Proposal For Denver Tga Ryan White

Draft Directive Regarding Substance Abuse and Mental Health Services

Research regarding substance abuse and mental health services has emphasized the following: 1. Due to stigma, people in need of counseling services are often initially reluctant to self-disclose need. Evidence based screening, respectfully delivered by competent interviewers, is essential. 2. Substance abuse and mental health counseling practices and content vary considerably from one provider to another. There is variation in terms of in treatment modalities and the severity and types of problems the provider is qualified to address. There are well-established guidelines (published by American Society of Addiction Medicine) that include placement criteria, based on client characteristics. Sending clients with severe need to under-qualified providers is potentially wasteful and can prolong or worsen suffering. 3. Treatment philosophy varies dramatically from one provider to another. To match client needs and preferences, it is important to have a spectrum of philosophical approaches available, including harm reduction approaches. 4. A significant number of substance using clients successfully lower or stop substance use without formal drug treatment. However, this does not mean that such clients do not need support, including support maintaining the changes they have made. 5. If a substance abuse intervention occurs early, before clinical levels of dependence have emerged, very brief counseling or therapy can be extremely effective, delivered at very low cost, with high degrees of client acceptance. At the other end of the spectrum, there is a distinct group of individuals for whom nothing short of intensive residential treatment will be effective. 6. HIV itself, and several HIV medications, have serious psychological side-effects. Some psychoactive medications, legal and illegal, also have an impact on HIV medication efficacy. Coordination among mental health, substance use, psychiatric, and HIV medical care are critical. 7. Mental health and substance use disorders frequently co-occur among people living with HIV or AIDS. Treating one without treating the other is inappropriate and potentially harmful. In light of these and other findings, the following directive is respectfully submitted: 1. That a sub-committee operating under MDASC be charged with the task of investigating research and other evidence regarding mental health and substance abuse services, particular screening, placement/referral criteria, and the spectrum of modalities and philosophies available and needed. 2. That the sub-committee develop and present recommendations regarding the standards of care, the priorities process, and other aspects of service delivery deemed necessary to improve the quality and availability of appropriate, effective mental health and substance abuse services.