Service use and outcomes for individuals with co-occurring severe mental illness, personality disorders, and substance use disorders

Many research studies have considered co-occurring relationships of severe mental illness (SMI) and substance use disorders (SRD), but there have been few studies that focused on individuals with co-occurring SMI, personality disorders (PD), and SRD. Treatments for those with co-occurring SMI and SRD are well documented to be difficult and costly, and often inappropriate, as these individuals move through services that might not adequately meet their needs. However, very little information is available on individuals with all three co-occurring disorders.

To understand the needs of individuals with SMI, PD, and SRD, community service use and negative outcomes (criminal justice encounters, emergency service use, admission behavioral health (BH) hospitals, and death) will be described and compared to individuals with SMI, SMI/PD, and SMI/SRD. This analysis will use four years of data for individuals who were discharged from Nebraska's BH hospitals in 2005, and fall into one of the four groups above.

We hypothesize that those with SMI, PD, and SRD are more likely to use community-based services and, if their service needs are not met, are more likely to have a negative outcome than individuals with SMI, SMI/PD, or SMI/SRD. Analysis will compare frequency and consistency of service use and the effect of access to care to negative outcomes. Data from community services, Medicaid, social services, Nebraska Crime Commission and Nebraska Department of Corrections will be used. These analyses will help providers and policy makers identify service needs for those individuals with mental illness, and aid in effective allocation of resources.