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Gazette Opinion

When a person is addicted to alcohol or other drugs, he can get treatment from addiction specialists. When a person suffers from a mental illness, he can seek help from psychiatrists and other mental health care professionals. But when someone is both addicted and mentally ill, a whole system of barriers stands between the patient and effective help.

“Mental health wouldn’t treat chemical dependency. They’d say, ‘Come back when you’re sober,” says Gary Mihelish, a Helena leader of the National Alliance for the Mentally Ill. “Chemical dependency won’t treat psychotic patients.”

“We need to change the treatment system,” says Mihelish, who was one of 80 Montanans who met last week in Billings to work toward that goal of integrating treatment for chemical dependency and mental illnesses. The participants invited by the Montana Department of Public Health and Human Services included legislators, Indian program representatives, mental health care professionals, chemical dependency treatment professionals and leaders of state agencies that deal with mental disorders, addiction disorders and prisons.

The health care system must treat the whole patient. To those of us outside the system, it seems like a no-brainer that people who need help for two serious problems should be treated for both problems. Now the professionals are recognizing that fact.

Problems often found togetherHistorically, mental health care and substance abuse treatment have been separate disciplines, yet somewhere between 30 and 70 percent of all patients treated for mental illness and substance abuse have both types of problems, according to Gail Gray, director of the state Department of Public Health and Human Services.

The divide between chemical dependency and mental health care extends to payments as well. Government programs have varying eligibility requirements and benefits. Private insurance may pay for mental health care, but not for addiction treatment.

Bob Ross, executive director of the Mental Health Center in Billings, estimates that 30 percent of the center’s patients with serious mental illnesses also have some level of chemical dependency or abuse. When mental health workers are called to local hospital emergency departments, 70 percent of the cases involve individuals who are both intoxicated and mentally ill.

Out of the boxRoss agreed that the system isn’t working. He said that treatment providers in Billings are recognizing this is a community problem that must be solved by thinking “out of the box.”

The three-day Billings workshop ended with sessions on brainstorming ideas that would work in Montana communities. Gray said the community strategies must be practical and not cost a lot of money.

Even with those parameters, progress is possible. As a start, agencies and entities that haven’t always had good relationships were sitting together in the same room for three days. They were talking about establishing working relationships, about expecting to take care of a patient’s addiction and mental health care. That’s the right prescription for people who need care and for those who are paying the bills.