Arizona has a federal Substance Abuse and Mental Health Services Administration (SAMHSA)
Integrated Treatment Consensus Panel grant to support statewide consensus building and
technical assistance related to the implementation of best practice integrated dual diagnosis
services. Under this grant, the state has received consultation from some of the foremost
experts in the field of co-occurring disorders. The anticipated outcome of this process is the
development of state policies, practice guidelines, and training curricula to foster implementation
of integrated services and competencies throughout the Arizona public behavioral health
LADDER Program (Life Affirming Dual Diagnosis Education and Recovery)
The Ladder day treatment program serves the seriously mentally ill who also have a substance
abuse problem. All clients are on psychotropic drugs, have an assigned case manager, and are
SSI or SSD eligible. The program is highly structured and offers a variety of groups on illness
management and recovery. Transportation to and from outside medical appointments is
The program serves approximately 80 people annually, with an average of 22 clients at any
point in time. The average length of stay at LADDER is three months. The program serves to
train clients in every day life skills and is believed to be effective at keeping clients safe and out
of the hospital.
Caulfield Center, near Boston, Massachusetts. This Center, started by Dr. Kenneth
Minkoff,21 has developed and proven the major tenets of integrated treatment (i.e., definition as
lifelong disorders, effective use of rehabilitation models, the need to address stigma, etc.) The
program combines substance abuse and mental health treatment on an individualized basis,
and is adjusted to both the individual's specific diagnoses and her/his phase of recovery.
23 Warren Ave.
Woburn, MA 01801
In New Hampshire, integrated treatment of individuals presenting with co-occurring disorders is
commonplace, and is the expected mode of treatment for the public mental health system for
EXAMPLES OF GERIATRIC SERVICES
Gate Openers - PGBHA
This program provides outreach to isolated elders to identify signs of isolation, poor nutrition,
health problems, etc. Individuals who would normally come in contact with isolated elders, such
as postal workers and delivery people, are trained to identify elder with needs and to notify the
area mental health center which has trained case management staff who will reach out to elders
and engage them in services. The service is coordinated with the local Area Agency on Aging
(AAA), which facilitates access to socialization, nutrition, primary health care etc.
The program has reported the following benefits: Reduced isolation, reduced risk of
hospitalization and/or negative health consequences, improved access to physical and
behavioral health services, and improved coordination of geriatric health services with other
The Bazelon Center has identified a number of programs that meet the above criteria for
competent and integrated elder behavioral health programming. These include the Elderly
Services Program in Spokane, WA, the Older Adult Services Program in Detroit, MI, The
Philadelphia Mental Health Corporation in Philadelphia, PA, and Gulf Coast Jewish Family and
Mental Health Services in Florida.
Bazelon Center for Mental Health Law
EXAMPLES OF HOUSING
Vera French Housing Development Corporation
In Davenport, Iowa, the Vera French Community Mental Health Center (VFCMHC) recognized a
need for supported housing for persons with mental illness. Persons served in their system
needed housing, but not a placement in a treatment setting or the county care home operated
by the VFCMHC. With broad participation of stakeholders, including DHS, Scott County, HUD,
community leaders, the Chamber of Commerce, the Real Estate Board, NAMI, Iowa, and local
banking and finance representatives, they formed the Vera French Housing Development
Corporation (VFHDC). This non-profit developed a housing plan and financing strategy aimed
at leveraging federal, state, and local funding and technical assistance.
The VFHDC now is responsible for over 120 units, including single family homes duplexes, and
a couple large apartment buildings for persons with mental illness and development disabilities.
Because VFHDC was an outgrowth of the VFCMHC, there are natural linkages with the services
of the VFCMHC, including case management and other supportive services. Over the past
couple years, the program has involved other local ecumenical organizations, and organizations
concerned with homelessness and poverty to secure grant funding for continued development
projects in the community.
1441 W Central Park Ave
Baltimore Community Housing Associates
In 1992, Community Housing Associates (CHA), Inc., completed the purchase and rehabilitation
of 15 residential properties in Baltimore, Maryland, to provide affordable housing for adults with
mental illnesses. CHA blended private and public funding to develop the project, and made
innovative use of case management services to provide supports to its residents. The CHA
project is a useful model for mental health or community development agencies interested in
developing housing for people with mental illnesses.
Baltimore Community Housing Associates
201 E. Baltimore St., Suite 1340
Michigan Supported Housing Development
In Michigan, several demonstration programs are underway to develop and support housing for
low-income and special needs populations. The program strives to develop permanent
independent living residences in non-institutional settings that offer access to other community
services. The Michigan Department of Community Health has joined with the Michigan State
Housing Development Agency (MSHDA) and the New York City-based Corporation for
Supportive Housing (CSH) to initiate demonstration programs in four Michigan sites to develop
affordable supportive housing for individuals who are homeless or at risk of becoming homeless,
including those with psychiatric disabilities. The program will explore ways that state health
(including mental health) and housing agencies can work together, in cooperation with other
public and private organizations, to provide housing and supportive services to individuals who
have very low incomes and special needs.
Local nonprofit sponsors selected by community-level partnerships will develop about 300 units
of housing. Funding for the initiative will come from state allocations of federal housing and
development program moneys including H.O.M.E., Community Development Block Grants
(CDBG), low-income tax credits, and donations from private sources such as foundations. CSH
will assist nonprofit housing developers to build organizational capacity and will provide bridge
financing. To date the program has generated $650,000, with the goal of reaching $1.4 million
for capacity building and bridge financing.
Michigan Supported Housing Development
EXAMPLES OF EMPLOYMENT
In New Hampshire, increasing the number of individuals with serious mental illness in
competitive employment has been a priority for many years. The state sets performance
targets, and measures each community mental health center against these targets. This had
the effect of having all local service components working towards the same goal - to see that
consumers found and kept competitive employment or other productive activity of their choice.
In Wisconsin, state behavioral health dollars have been used to match federal VR funds to
create VR capacity in rural areas. The behavioral health system then uses ACT teams to
provide all the pre and post employment services and supports that are not provided through VR
In several jurisdictions in Michigan, VR staffing and equipment grants have been used to
enhance the capacity of psychosocial clubhouses to provide meaningful training and
employment experiences that are relevant to the local employment marketplace.