SERVICES FOR PERINATAL WOMEN WITH SUBSTANCE-ABUSE AND MENTAL-HEALTH DISORDERS - THE UMMET NEED

Dual diagnosis refers to the co-occurrence of substance abuse and ment al illness, which may take many forms. Women who abuse alcohol or drug s are more likely than men to be diagnosed with a psychiatric disorder , particularly depression or personality disorder. The interaction of pregnancy, addiction, and mental illness creates complex needs that of ten go unrecognized by treatment providers. Clinical issues concern ad equate prenatal care, use of medications while pregnant and/or nursing , maternal bonding, and coordinated treatment planning among medical, addiction, and mental health treatment providers. Barriers to service delivery to perinatal substance-abusing women with a mental illness in clude the difficulty in diagnosing a dual disorder, child care and cus tody concerns, lack of health insurance or funds to pay for treatment, and the stigma associated with mental illness and addiction. Services currently available for the dually diagnosed are typically fragmented and uncoordinated and provision of those services is often hampered b y philosophical differences, categorical funding, competition for scar ce resources, inadequate staff training, and lack of a central adminis trative authority or mandate. Several models have been suggested that coordinate services for the dually diagnosed. Awareness of the service needs of dually-diagnosed perinatal women must be included within the se models and integrated at all levels of the treatment system.