Comorbidity of mental illness and substance use disorders is common, and comorbidity is reported by service providers as the expectation rather than the exception (Hall, Lynskey, & Teesson, 2001). Many treatment service models are being used to treat this complex group in the alcohol and other drugs (AOD) and mental health (MH) sectors on a best-fit and situational basis. As AOD and MH services are administered and funded separately, there has been little incentive for examining and collaborating on good practice. Further, few studies have systematically reviewed service delivery in this context.
In acknowledging the prevalence and problems associated with comorbidity, the Australian Government launched the National Comorbidity Project in 2000, which brought together the National Drug Strategy (Australian Government, 2008a) and the National Mental Health Strategy (Australian Government, 2008b) coordinated by the National Drug and Alcohol Research Centre (Teesson & Burns, 2001). Areas for action were identified including greater interaction or collaboration between services and building the capacity of services to enhance their response to co-existing drug and mental health problems (Ministerial Council on Drug Strategy, 2004). Despite this and other state, territory and agency initiatives to minimise barriers to treatment and build strong partnerships between drug treatment and mental health services (Australian Health Ministers, 2003; COAG, 2006; DHS, 2007a; DHS, 2007b; NSW Health, 2000a; NSW Health, 2000b), recent findings indicated that people with a history of illicit drug use and co-occurring anxiety or depression are still not well-serviced by AOD and MH services in Australia (Holt et al., 2007; Treloar & Holt, 2008).
The Comorbidity Treatment Service Model Evaluation project was funded by the Australian Government Department of Health and Ageing, (DoHA) under the umbrella of the National Comorbidity Initiative.
The aims of the Comorbidity Treatment Service Model Evaluation project were to:
- Conduct necessary research to determine good practice, and thereby facilitate improved treatment outcomes for people with co-existing mental health and substance abuse problems.
- Increase understanding of the impact of service structure on comorbidity treatment outcomes, as well as develop good practice model(s) to ensure improvements in comorbidity treatment service delivery.
- A literature review to determine the evidence base for different comorbidity treatment service delivery models.
- Development of a treatment service model evaluation tool to gather information on the impact of service delivery models on treatment outcomes.
- Evaluation of 17 comorbidity treatment service models with a focus on the service structure and diagnostic and treatment methods (the focus is not on the detail of methods of assessment, diagnosis, interventions, and client outcomes, unless these are related to the type of treatment service model).