For the 8.9 million American adults — about 500,000 Californians — with a dual diagnosis of mental illness and substance use disorder (SUD), it can be difficult to receive the fully coordinated and effective care they want and need. For people with low incomes, the barriers can be even higher. Many of the obstacles stem from the structural separation of mental health and SUD services into two different funding and delivery systems, but there are cultural, financial, and professional factors as well. A frequent result for patients is unnecessary suffering from their illnesses, while families and friends experience continuing stress as they search for effective help for their loved one. To understand the experiences of Californians with dual diagnoses and the families and friends who support them, CHCF funded a study by social science research organization NORC at the University of Chicago. The researchers identified and interviewed people with in-depth personal or professional knowledge about dual diagnosis. Through these interviews, the project aimed to shed light on the real-life obstacles to treatment and good outcomes and to identify current practices that are working well. NORC interviewed 93 people, including: (1) 54 people with dual diagnoses and currently in treatment for mental illness, SUD, or both (2) Nine loved ones — either family members or close friends — of people with dual diagnoses (3) 20 direct care providers, five provider administrators, and five subject matter experts. The firsthand experiences of people with dual diagnoses and their family members and close friends are the central focus of this report. Interviews with direct care providers, provider administrators, and subject matter experts provide context and highlight structural and cultural impediments to care for people with dual diagnoses.
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