The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67699

Carrie C. Brogoitti, Sage Bernard Foster, MA, and Paul Koch. Department of Health Education, San Francisco State University, PO Box 170686, San Francisco, CA 94117, 415-640-4455, carrie@sfsu.edu

San Francisco's Department of Public Health’s (SFDPH) Community Mental Health Services and Community Substance Abuse Services divisions strive to implement and maintain programs and services addressing the needs of individuals with co-occurring mental health and substance use conditions. To support these efforts, three San Francisco State University Master of Public Health students interviewed a convenience sample of 16 patients admitted to a psychiatric ward at San Francisco General Hospital in October 2002. The assessment was designed to elicit qualitative information about clients’ perception of SFDPH services and gain insight regarding their barriers to linking with outpatient services after hospital discharge. Eligible interviewees were dually diagnosed “hospital recidivists” (patients having two or more inpatient hospitalizations over the past continuous 24-month period). Patients meeting study criteria were identified using a Billing and Information Systems records and consultations with hospital staff. After providing informed consent, face-to-face, semi-structured interviews lasting 20-45 minutes were conducted. Participants received $20 for their time. Interviews were transcribed, coded, and summarized into themes. Key themes included fluid motivation for treatment, difficulty adhering to prescribed medications, and unstable/undesirable housing. The data suggested that problems and gaps in services implicate individual, community, and system wide approaches. The larger implications touch upon County policy, e.g., response to homelessness/housing and demonstrate the importance of considering strategies that address multiple levels. Individual level interventions should be enhanced by addressing broader systemic and environmental issues that impact individual needs. The fact that individuals function within the context of the community and system cannot be ignored.

Learning Objectives:

• Recognize dually diagnosed client’s perspective regarding
• what services do/do not work for them;
• self-perception of their “problem”;
• motivation for change; and
• client/system barriers to linking with outpatient services.
• List at least three themes identified by dually diagnosed clients related to available services and barriers to linking with outpatient services.
• Identify at least one method to promote individual behavior change among dually diagnosed individuals and the communities and systems that serve them.

Keywords: Mental Health, Co-morbid

Awards: The Kenneth Lutterman Award for Exemplary Student Papers in Mental Health - Honorable Mention

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.