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Mental health treatment providers are continually challenged to improve services. Often, these challenges occur in a fiscal growth environment that is not only flat, but in most instances, declining. Over the past 15 years, there has been an increased awareness of the common presentation of persons with co-occurring substance use disorders in routine mental health treatment settings, especially among patients with severe mental illness who are often the primary consumers of state-funded mental health treatment services. Research results suggest that sequential treatment (treating one disorder first, then the other) and purely parallel treatment (treatment for both disorders provided by separate clinicians or teams who do not coordinate services) are not as effective as integrated treatment (Drake, O’Neal, & Wallach, 2008). National and state initiatives related to co-occurring disorders have been significant, stimulating considerable interest in providing better services for people with these challenges. Although clearly interested in so improving existing services, mental health treatment providers have to some extent lacked pragmatic guidance on how to change. Specific evidence-based treatment practices have been developed, including Integrated Dual Disorders Treatment (IDDT; Mueser et al., 2003; SAMHSA, 2003). However, providers continue to identify the need for practical guidance and specific benchmarks with which to plan and develop services.

The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) index was first developed in 2004. The DDCMHT is a parallel instrument to the Dual Diagnosis Capability in Addiction Treatment (DDCAT) index. Both indices are based on the American Society of Addiction Medicine’s (ASAM) taxonomy of program dual diagnosis capability and have been subjected to a series of psychometric studies. The map below reflects the widespread implementation in various stages of the DDCAT, DDCMHT, and another parallel instrument, the Dual Diagnosis Capability in Health Care Settings (DDCHCS). The DDCMHT, described more fully below, guides programs and system authorities in assessing and developing the dual diagnosis capacity of mental health treatment services (McGovern, Matzkin, & Giard, 2007).

States Using Dual Diagnosis Capability Assessment Measures, as of April 2011. The 32 States, District of Columbia, and Navajo Nation are shown in the map image using DDCAT/DDCMHT/DDCHCS in 2011 are: Alaska, Arizona, Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Navajo Nation, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont, Virginia, and Washington.

This toolkit emerges from these efforts. It is a response to numerous requests by community treatment providers for more specific guidance on how to enhance services based upon their current status. For programs that the DDCMHT determines to offer services at Mental Health Only Services (MHOS) level, this toolkit provides specific suggestions and examples from the field on how to reach Dual Diagnosis Capable (DDC) level services. Likewise, programs already assessed at the DDC level have asked for specific guidance on how to attain the Dual Diagnosis Enhanced (DDE) level. This toolkit addresses those requests as well.

The motivation among mental health treatment providers to improve the quality of care offered to their patients is impressive if not inspirational. This toolkit was developed in direct response to mental health treatment programs at the “action” stage of readiness. The toolkit is designed to immediately offer practical tools and useable materials that will rapidly improve services to those programs with co-occurring disorders entrusted to their care.