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Many Americans know of someone who has suffered from a mental health or substance use problem – whether it is a family member, friend, co-worker, or themselves. These issues do not discriminate based on age, gender, race, education, or income. Ensuring that all individuals receive treatment and support that is applicable to their unique needs and circumstances can have widespread personal as well as financial and societal implications. At Heartland Alliance for Human Needs & Human Rights, we believe that access to health care, including treatment for mental health and addictions, is a human right.

In 2006, there were an estimated 24.9 million adults aged 18 or older in the United States with serious psychological distress at some point in the past year. Less than half of those needing help received treatment. During that same year, the number of persons aged 12 or older needing treatment for an illicit drug or alcohol problem totaled 23.6 million, while only 10 percent received treatment. In 2006, of the estimated 5.6 million adults with both mental illness and a substance use problem, half received one type of treatment or the other, while only 8.4 percent received treatment to address both issues. In effect, there are millions of Americans suffering with mental health and addictions issues without access to treatment. 

Heartland Alliance is a leading provider of community mental health and addictions services in Chicago, providing a diverse array of mental health, case management, and outreach services to particularly marginalized individuals – those who are homeless, are refugees, or are living with HIV/AIDS. As a direct service provider, Heartland Alliance has extensive expertise developing, implementing, evaluating, and improving programs and services that provide mental health and addictions treatment. Through programs and services across the spectrum of mental and physical health, Heartland Alliance is leading the way in providing innovative and effective solutions to some of our nation's most pressing issues. The following principles for effective mental health and addictions service and treatment guide our direct service work and our advocacy efforts:

Offer treatment options across the continuum of need

Effective treatment requires meeting people at their point of need. Heartland Alliance employ's a treatment philosophy know as harm reduction based on the belief that substance users can be effectively engaged in services regardless of whether they currently abstain from drug use. Its aim is to reduce the harm of substance use and other high-risk behaviors by maximizing access to and minimizing loss of housing, while taking into account the rights of the individual along with the needs and well being of the community.

The harm reduction approach promotes the human rights of all individuals by offering a continuum of service options and strategies that include abstinence as a goal for some, while embracing and celebrating steps that reduce harm along the way and improve the quality of life for others. Harm reduction housing or a "housing first" approach, emphasizes finding permanent housing for individuals, then following it with counseling, substance abuse treatment, and employment services. While often focused on drug use, the philosophy of harm reduction can be applied to other populations and high-risk situations.

Integrate care for individuals with multiple barriers

A significant number of individuals with a mental illness also have a co-occurring substance use disorder. Typically, people with dual diagnoses who seek help rotate between the mental health and substance use systems, sometimes receiving treatment from one or the other of their illnesses – but more often receiving no treatment at all. Individuals rarely move neatly from point A to point B on the treatment or recovery continuum. Serious mental illness and addiction are chronic, recurring problems, which follow unique and individual courses. Rehabilitation is an incremental process that occurs slowly, and sometimes on differing timetables for different illnesses.

Integrated care is an evidence-based treatment approach that aims at addressing the needs of individuals diagnosed with both mental illness and substance use problems to help ensure effective care. Multidisciplinary treatment is used to provide services along the continuum from outreach and crisis intervention to relapse prevention.

Address cultural differences with targeted care approaches

As the American population continues to grow in diversity, the need for programs and services that address unique language and cultural differences is on the rise. Cultural competency involves the provision of on-site interpreter services, written materials translated into a variety of languages, and treatment approaches that account for unique cultural needs. The need for culturally competent care grew out of research that documented higher incidences of sickness, limited access to quality health care services, and lower life expectancy among communities of color and limited or non-English speaking patients compared to their white and English speaking counterparts. However, this model can also be applied to unique populations, such as people experiencing homelessness, living with HIV/AIDS, or other groups with experiences and needs that benefit from a targeted approach. The model empowers treatment providers to build close relationships with participants of diverse backgrounds and provide client-centered services. Participants can grow to trust that providers have their best interests in mind and work together as a treatment team. 

Enact policy change that integrates best practices and effective solutions

Based on Heartland Alliance's unique service-based expertise, we support the following policy and funding strategies to strengthen mental health and addictions treatment in communities across the U.S.

• Congress must enact legislation that ensures that mental health and substance use disorders receive the same insurance coverage as physical illnesses.
• State and federal governments must repeal any and all policy that restricts the use of public funds that support effective strategies such as harm reduction, integrated care, and cultural competency. 
• Congress must pass legislation that directs states to invest in effective strategies such as harm reduction, integrated care, and cultural competency, and allocates funding specifically to support such programs and systems.

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