Addressing Co-Occurring Disorders Simultaneously Saves

Lives & Money while Alleviating Human Suffering

Debbie Webb, Ph.D., LCSW, LPC, LCDC

Executive Director, PLANCTX

Assistant Professor, St. Edward’s University

DDX Consultant

Founder, Good Chemistry Groups

Thank you!• Thank you for selecting to attend this

workshop today. The topic is very important to us all!

• A special thank you to Kenneth Placke of ATCMHMR for inviting me to be a part of the Texas Council of MHMR Center’s presenters this year.

• As some of you may already know, I “retired” from ATCMHMR after 23 years of service a year ago in May.

Free to Advocate! • One major reason I was ready for my next

adventure is that I felt that it was time for me to be “free to advocate” (not just do invited “education” because of the Hatch Act) with legislators, both in Texas and nationally! It feels great!

• In one of my new roles, I represent the “families of persons facing mental illness,” & as a family member, it feels congruent!

Comfort Zone Warning!

• Therefore, be aware that this is designed to be an interactive experience! I’m inviting you to be involved! Jump in! Say what YOU think! You NEED to be able to do that! (I’m not simply going to lecture…I want to “facilitate” your consideration & discussion.

• We have some “hard” things to discuss! Let’s go there with courage and honesty!

It is imperative to continue wholistically addressing the needs

of persons with DDX & MDX • 1st Terminology Definitions: SDX; DDX; MDX• Despite the fact that we are practicing in a

strained economic time, & in the midst of “managed health care,” unmet significant needs among persons with DDX & MDX are causing great human suffering, grief from losses, & MI/CD relapse.

• What do they need? Let’s consider it!

Regardless of hard economic times, we must…

• The core premise of this presentation is: We MUST keep recognizing, acknowledging, & wholistically addressing the needs of persons with dual or multiple disorders!

• First, being able to recognize what persons with DDX or MDX need and deserve may not be “straightforward” and “obvious” as it may first appear.

Being able to recognize…• In Texas, we taxpayers, represented by

our elected legislators and other officials, do not and have never allocated enough money to effectively treat persons with mental illness. It is a travesty and social injustice that devastates many of our clients and their family members.

• Have we grown calloused and out of touch with the gap between what they need and what we actually have to offer in services?

Your Role is Challenging!• At MHMR Centers across Texas, I know

you consistently & efficiently do the MOST you can with what little resources you have! I respect & applaud you!

• But, with the ever-increasing direct service micro-level demand so great, do you make the time and expend the extra energy necessary to likewise monitor and “educate” at the macro-level big picture?

Disconnects• Who knows, besides you and your co-workers,

what your Center DOES NOT offer, but NEEDS to offer in your community, and how very much you need a way to pay for it??

• Have we grown complacent? • Have we simply “accepted” our state and federal

allocations as “reality” and quit educating about the extensive unmet needs?

• Is it ungrateful or wrong to ask for more? • Are we tired, worn thin, overwhelmed?

Check YOUR Logic! • Is your “logic” regarding possible solutions to

DDX client needs sound? Remember, if your premises (suppositions) are wrong, your logic is flawed.

• If we believe that mental health services will always be poorly funded in Texas, no matter what we do, and “go on from there,” we are part of the problem!

• Are we also looking “outside” the “box” of what resources we have already been allocated? This has helped Texas Crisis Svcs! What about the rest? Are monthly SSDI and SSI payments sufficient income on which to live, for example?

Wholistically addressing the needs of persons with DDX & MDX, cont.

• To me, “wholistically” implies considering & focusing on the “whole” of what the person needs or “all” of their needs at one time.

• Thus, it is different than addressing things or needs “piecemeal.”

• Lack of a basic necessity for life is NOT acceptable! What would you do for a diabetic out of insulin? How is that different than what mountains you would move for a person with needs who has MI, DDX or MDX?

• Similarly, one might select the word “comprehensive” as the best description of the type of services a person with DDX or MDX truly needs. This takes money & resources!

What actually “costs” more? • In fact, “comprehensive” outpatient assessments

& services may seem too expensive. • But, when under-service or lack of services &/or

basic resources winds up hastening undesirable outcomes, such as relapse and even worse, it is obvious that investing a medium amount now is less expensive/more cost efficient than having to pay a great deal more, later as level of care required goes up as unaddressed illness(es) exacerbate!

• Pay less now? (proactively) Or Pay more later? (cost shifting; deinstitutionlization, etc.) We will Pay, regardless! So, which makes most sense?!

The Balcony Macro-Level View• Have you ever watched a play from a

balcony? How many characters can you easily monitor from that perspective versus “on the ground” level on stage?

• You can see them all and their positions changing in relation to one another from the balcony. It’s like touching a baby’s crib mobile. As one thing moves so do others.

• This is why in SW capstone classes we call gaining a new perspective going to the balcony and looking down on the situation.

Climb into the Balcony: “IF”• IF we were taking a macro-level snapshot

of our clients lives who are facing DDX or

MDX, what needs do you think we are most likely to see today? Give a short descriptive label of as many as you can:

• [Audience Brainstorming in Pairs]

• [Audience Report Out]

• [Facilitator Synthesis of Audience Reports]

Being Heard @ Macro-Level!

• I would venture to guess no or not very often. This is a problem!

• YOU know the most because you are the CLOSEST to the issues/challenges, and so your ideas for solutions are the most pragmatic and most likely to work!

• But, are your knowledge and “voice” being lost at the influential, political macro-level?

ADDRESS the SOURCE(S)!

• It’s SO IMPORTANT to identify the SOURCES/CAUSES of a problem and address it, while simultaneously helping those affected by the problem! But, RESERVE some energy and resources to address MACRO-Level! It is NOT an “OR” situation; it is an “AND” and we need to see it that way!

• Examples:• Micro-level only: Starfish!• Micro & Macro: Babies in the River!

Bringing it Home to DDX & MDX!

• News flash! Research continues to show people with DDX and MDX DO respond to the treatments we already offer! They may need more time to engage, but treatments work!

• No one particular treatment is far superior in outcome to another! But, workers need to be able to ACCESS the ENTIRE continuum of services on behalf of any given client at a point in time, depending on what s/he NEEDS, not on what we have become accustomed to “settling for!” It might be outpatient, respite, inpatient, etc.

True Suicide Prevention• Suicide rates: 10% among those with

schizophrenia; • Even higher with all DDX and MDX

combinations: ETOH and other drugs hasten suicide attempts!

• What do YOU think might make these folks “give up” and see no other option besides suicide?

• What can YOU do to PREVENT HOPELESSNESS?

• YOU are powerful because you MANAGE RESOURCES! But HOW can we get MORE?

Prick our Conscience!• You are ALREADY saving many lives!• 10% of your clients are NOT dying by

suicide!• But, how many are “living” in poverty, filth,

hunger, in abysmal circumstances, homelessness, etc.?

• How many actually have “quality of life?” • How can you be MORE PROACTIVE &

PREVENTATIVE vs. reactive? Assess! Plan! Address! Manage! Maintain!

Family Resource • The biggest “provider” IS the FAMILY! • HOW OFTEN and HOW WELL do YOU

incorporate the family into being part of the solution/the “team?” What is YOUR self-assessed “grade?”

• Does your Center have a policy and procedure to designed to proactively ask stable clients if they want to sign releases for key family members? I encourage you NOT to waste this valuable, often highly motivated resource!

• Don’t “hide” behind HIPAA! Honor its’ spirit plus be proactive! At crisis time, it’s too late!

SOLUTIONS! Trust Your Own Judgment!

• What CAN “I” do to CHANGE this situation for the better? (Each of us DOES make a difference! “Pain” into help! GC example.)

• What affordable resources do I need to work toward attaining in my community? Accessible medications (preventative/before a crisis), food, supported housing, supported employment, volunteer opportunities, safe and fun social and recreational avenues, etc. [Audience, add yours!]

• What power broker do I need to partner with at the macro-level to see this through? State-level?

Thank you!• I hope this time together stimulated your thinking!• YOU KNOW what to do! Go for it! Don’t take “no”

for an answer! Don’t delay! • Thank you for this opportunity to explore these

issues with you! I appreciate how very hard your roles are and what you do on behalf of the public interest every day!

• If you want to reach me, please write me at debbiewebb@aol.com or call me at (512) 799-9358. Thanks!