Service problems and solutions for individuals with mental retardation and metal illness

Journal of Rehabilitation, Jan-March, 2003 by Jill L. VanderSchie-Bezyak

The Community Specialist Psychiatric Service

Another example of effective service is the Community Specialist Psychiatric Service (CSPS) in London. Initially, interdisciplinary teams were formed by England's National Health Service to support people with developmental disabilities in the community, but plans for mental health services for these individuals were not made until the development of CSPS, which provides clinical and consultative functions (Davidson et al., 1999). A CSPS clinician becomes involved with the team if a mental health diagnosis is suspected and provides assessment, home-based support, outpatient care, and inpatient psychiatric treatment. In the consultative role, clinicians in this program provide not only expertise on dual diagnosis to the interdisciplinary teams, but also education to relatives, service coordinators, and other organizations involved (Davidson et al., 1999). CSPS is an excellent example of a program that employs qualified clinicians to provide direct services to clients, while also educating and training other individuals involved in a client's life.

The ENCOR Model

The Eastern Nebraska Community Office of Retardation in Omaha, Nebraska, was designed almost two decades ago to promote community involvement and citizen advocacy for people with developmental disabilities and individuals with dual diagnosis (Davidson et al., 1999). Approximately 19% of the individuals served by ENCOR have a dual diagnosis, and the types of mental illness among this population include schizophrenia, personality disorders, and anxiety disorders, among other diagnoses. (Fletcher, 1993; Menolascino, 1989). Clients with dual diagnosis who are served by ENCOR can be classified into three levels of involvement; Level I includes people who present daily behavioral management problems; Level II includes of people with occasional behavioral problems; and Level III includes people with infrequent behavioral problems. This classification does not make service provision dependent on a specific diagnosis; rather personnel, supports, and services are determined by the level of a client's need (Menolascino, 1989). Along with this classification system, ENCOR has a policy of zero rejection, which means no individual will be denied services due to the severity of the mental illness and/or mental retardation (Fletcher, 1993). In addition, ENCOR is committed to active treatment of people with dual diagnosis and continually works to link professionals from local mental health and mental retardation programs (Fletcher, 1993). ENCOR's services include family support, specialized group homes, crisis assistance programs, preschool services, in-home teachers, integrated job placements, and inpatient/outpatient care provided by psychiatric professionals (Davidson et al., 1999). The specialized clinical staff at ENCOR become involved in nearly every aspect of the client's life in order to provide the most effective services possible.

The Interface Model

The Interface Program was developed over two decades ago in Cincinnati, Ohio, to provide multi-system services to individuals with dual diagnosis (Woodward, 1993). Although the Interface Program is funded by the Hamilton County Community Mental Health Board, it is administered by the University Affiliated Cincinnati Center for Developmental Disorders, which removes primary responsibility from both the mental health and mental retardation/developmental disabilities service systems (Davidson et al., 1999). The Interface Program is composed of three dual diagnosis specialists and one coordinator with responsibilities in the development and implementation of individualized service plans, provision of necessary mental health and mental retardation services, maintenance of effective interdisciplinary team characteristics, data collection on dual diagnosis subgroups, and local and regional educational programs (Davidson et al, 1999; Woodward, 1993).