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Experts Urge Integrated Treatment For Trauma, Mental Illness

Women with mental illnesses often have been abused physically or sexually. A recent government study found that the most effective counseling addresses their trauma and mental illnesses.

Studies of women in hospitals and prisons and homeless shelters have documented high rates of trauma and abuse.

Nonetheless, "the nature and impact of trauma remains too often misunderstood or neglected," commented Charles Curie, M.A., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), in a press release. As a result, most community mental health programs treat women for their mental disorders in isolation from the trauma they have experienced.

That situation may be changing, however. Last month SAMHSA released six-month findings from the second phase of a five-year study of women with mental disorders and a history of trauma.

The "Women, Co-Occurring Disorders, and Violence Study" is believed to be the first large, national treatment study of women with mental and substance abuse disorders and a history of violence-induced trauma.

Nine treatment sites throughout the United States enrolled 2,729 women aged 18 or older in the study. According to SAMHSA program officer Susan Salasin, "Most of the women were mothers on public assistance with comorbid health problems including HIV resulting from drug or alcohol abuse." This population typically uses a lot of health care services that tend to be "fragmented, less comprehensive, and more institutionally based than what they needed," she told Psychiatric News.

About 85 percent of the women in the study had been physically abused, and 82 percent had been sexually abused. Moreover, 81 percent had been diagnosed with a mental disorder, 65 percent had received treatment at the time of the study; 49 percent had been treated in or admitted to a psychiatric hospital or psychiatric ward of a hospital at some point in their lives; and 99 percent had used alcohol, marijuana, or crack/cocaine at some point in their lives.

The women were divided into two treatment groups: one group received the usual community counseling, and the other received comprehensive counseling that integrated the treatment of co-occurring disorders and trauma simultaneously.

Six months later, the 2,006 women still enrolled in the study were interviewed to determine whether their symptoms had improved.

Women who received the comprehensive, integrated counseling had significantly fewer symptoms of mental illness, alcohol use, and drug use than the women who received fragmented counseling. Symptoms of mental illnesses improved in 59 percent of the women receiving integrated counseling compared with 49 percent of the women receiving usual care.

Further, 50 percent of the women who received integrated counseling reported that they were no longer using drugs, and 54 percent said they were no longer using alcohol.

By comparison, 34 percent of the women receiving usual care reported no drug use, and 37 percent reported no alcohol use.

"The cost of providing comprehensive care including integrated counseling was-n't greater than the cost of providing usual care," Salasin commented. "The combined intervention was cost-effective because it produced better outcomes than usual care."

The "Women, Co-Occurring Disorders, and Violence Study" is posted online at <www.wcdvs.com>.

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