Systems issues in serving the mentally ill substance abuser: Virginia's experience

State service delivery systems have had limited success in meeting the needs of persons with major mental illness and substance abuse problems. Systems issues that create barriers to effective services include rigid program boundaries, inadequate assessment and diagnosis, lack of trained staff, the limited array of special services, and inflexible funding patterns. The state of Virginia, which administers mental health and substance abuse services through a single agency, has addressed these issues by clearly communicating that services for mentally ill substance abusers should be given high priority, by instituting a collaborative working relationship between mental health and substance abuse services, and by providing funding incentives. Additional efforts to develop advocacy organizations for mentally ill substance abusers, to train mental health professionals to serve this population, and to improve program evaluation and assessment are needed.