A person with a severe mental health problem who does not have access to follow-up, psychological care or treatment is unfortunately unable to be admitted in to Vilavi’s treatment program. Our treatment facility in Terrebonne does not have the necessary resources to provide or insure follow-up for persons who require specialized or ongoing psychological care and resources.

However, if those people are able to obtain access to continuous care by a psychologist or a psychiatrist, and their mental health issues fall under the responsibility of their attending physician, Vilavi can address and treat the person’s substance abuse and alcoholism issues.

The focus of the article is not to provide detail about Vilavi’s practices in Quebec, but rather, draw attention to the greater challenge of treating people who have both substance abuse/alcoholism and mental health issues. It also illustrates the actual practices in the general model of therapeutic communities, including certain members of the Vilavi network in Europe and South America.

Over the years the therapeutic concept practiced in therapeutic communities has had to adapt to the growing understanding of the causes of substance abuse and the needs of the substance abusers.

It has also had to adjust to the evolution of the way in which the healthcare network and society views substance abusers and his behaviour. Thus, the « moral model » of the 60’s and 70’s, that viewed the drug addict as a deviant, gradually gave way to « the medical model », which in turn evolved into today’s prevailing « biopsychosocial model ». The wider lens of the latter model has permitted us to see the individual’s difficulties as resulting from a set of factors that linked together, including the person himself, his background, his environment and finally the substance(s) that he or she uses. This model has led the therapeutic community (TC) treatment model to offer individualized programs of assessment and intervention, performed by multidisciplinary teams consisting of drug counsellors, psychologists, youth workers and others, that are able to respond more effectively to better identified needs and, accordingly, to improve the quality of the services offered.

In first phase of this process, the role of the drug counsellor during pre-admission is critical, because the adequate development of the individual’s intervention plan, and consequently the program’s outcomes, will very much depend on the quality of the first interviews, on the overall understanding of the individual’s problems and on the adequate transmission of information to the multidisciplinary team.

How to Assess Mental Health Problems More Effectively

One of the major challenges consist in adapting the clinical approach to persons who are experiencing a combination of mental health disorders and the abuse of mood-altering substances. This is an important issue, because our experience, as well as the most recent studies, has shown that 50% of those seeking drug treatment also experience a concurrent mental health disorder, principally an antisocial personality or mood and anxiety disorders. Approaching an addiction problem without taking into consideration coexisting mental health problems limits the scope of intervention and puts the person at higher risk of relapse, depression, suicide, violence, or homelessness, as well as functional impairments such as unemployment and chronic interpersonal conflicts.
This situation motivated us to implement a procedure of intake and support more likely to optimize the quality and speed of the therapeutic response.

A three-steps procedure

  • Mental health screening
  • Assessment
  • Referral or integrated treatment

The first step of this procedure is a mental health screening, performed during the first interviews of the pre-admission phase(1). The objective of the screening is not to draw a complete profile of an individual’s psychological functioning and his needs for treatment, but rather to determine if the individual seems to experience a mental health problem, justifying a complete assessment by a psychologist.

Screening is done using various clinical instuments and questionnaires which take into account prior treatments for psychological problems and the experience of a variety of symptoms such as depression, thoughts of suicide, hallucinations or cognitive difficulties, not resulting from drug use. The results are transmitted to psychologists or psychiatrists, who then determine whether or not it is appropriate to carry out the second step of the procedure, the assessment, with the aim of either preparing a plan of intervention and follow-up suited to the individual’s psychological needs, or else referring him to another treatment resource.The purpose of the assessment is to develop a treatment plan that will, among other things, prevent the emergence of violent behaviour, preclude health deterioration, or respond to a potential suicide emergency.

What is at stake is critical, and the task is far from simple. Assessment is essential to preparing a future course of treatment, because a proper assessment will facilitate the psychologist’s job of sorting out all the interactions between mental health disorders and drug abuse.

Assessment should be performed as soon as possible after the individual has entered the program; however, a correct diagnosis can be made only after 4-to-6 weeks of abstinence. As a result, the treatment plan must be revised and adapted on an ongoing basis, in particular when the concurrent disorders do not improve after this period of abstinence.

Treatment of substance abusers who have a concurrent mental health problem, should go beyond the use of psychiatric or medical intervention alone. Intervention methodologies in TC’s are likely to reinforce these two approaches with a variety of tools inspired by cognitive behavioral treatment, that enable the individual’s to identify and understand his own perceptions adequately. In addition to enhancing behavioral skills related to community life per se, group workshops aim to understand better what role substance use plays in a person’s life and determine one’s individual way of functioning, the nature of the changes that are being made and eventually, how to maintain one’s achievements.

This combination of a drug abuse treatment program and psychological or psychiatric support is called integrated treatment. Through this approach all of the members of the multidisciplinary team, whether they belong to the TC staff or not, are working together, with coherence, to improve the person’s quality of life. To implement this notion of coherence effectively it is essential that the practitioners of these two fields of intervention work together, speak together and share their experiences in order to adapt their practices on an ongoing basis. This necessity emphasizes the critical importance of the partnership of public, community and private networking.

Responding to the needs of those experiencing drug abuse and mental health problems can only be accomplished effectively within the scope of a comprehensive effort that includes networking with community-based, private and public health organizations.

Pierre Bremond
Communication Consultant – Certified Drug Counsellor