OHA study finds complex, uneven treatment for Oregonians dealing with both mental health and substance abuse issues

SALEM, Ore. (KTVZ) — A study from the OHSU-PSU School of Public Health, commissioned by the Oregon Health Authority, shows that people living with both substance abuse and serious mental health issues experience a complex and uneven treatment landscape in Oregon, OHA reported Monday.

The study—based on self-reported provider data— found that overall, 82 percent of mental health providers and 40 percent of substance use providers in Oregon offer treatment for co-occurring disorder, defined as treatment for co-occurring substance use plus either serious mental health illness in adults or serious emotional disturbance in children.

However, the study showed that availability and types of COD treatment can vary substantially:

• Only half of mental health providers offer integrated treatment (combined treatment for mental illness and substance abuse from the same clinician or treatment team) and special groups for clients with COD.
• COD treatment is least likely to be offered in hospital and substance use residential settings.
• Only half of the treatment providers treat gambling disorders.
• Only about a third of providers offer programs for young adults or LGBTQ+ clients. Just over one-third of the programs offer services in Spanish, and half offer services in sign language.

The study found that acceptance of public insurance—especially Medicare—is low in some settings, which may be a barrier to access.

The study also noted that workforce shortages remain a key barrier to spreading and scaling co-occurring disorder treatment across the state.

Oregon has made concerted efforts over the years to support the uptake and availability of holistic behavioral health care, including treatment for those living with co-occurring disorders.

In 2021, the Legislature directed OHA to develop payment models for increasing access to integrated treatment, which led to the establishment of the Integrated Co-Occurring Disorder Treatment program.

Oregon was also one of the first states to open Certified Community Behavioral Health Clinics as part of a federal demonstration program that began in 2017.

Participating providers receive a single payment model for treating COD (including co-occurring intellectual and developmental disabilities and problem gambling), and receive training, technical assistance, and other resources to support provision of COD treatment.

They are required to provide nine core services, ranging from crisis services to peer support and counseling. They must also provide 20 hours of primary services per site.