Service enhancement to a dual-diagnosis population: mental illness/substance abuse (MISA)

Qual Manag Health Care. 2003 Jul-Sep;12(3):133-50. doi: 10.1097/00019514-200307000-00004.


This study details how the Sinnissippi Center, Inc., identified, eliminated, or modified barriers to accessing services for MISA (mentally ill and substance abusing) consumers to improve their level of functioning. Barriers and impediments to MISA consumers receiving the full range of services were identified; specific systems changes and modification and clinician help were implemented; and process measures, functional measures, and comparison measures were taken, as was fidelity to the improved service model. Comparison measures showed a significantly lowered dropout rate (5.5% versus 65%) for the MISA-specific group and improved functioning over the comparison group. Process measures showed a significantly lowered use of emergency services, reduced emergency psychiatric hospitalizations, increased sobriety, decreased global assessment of functioning ranges, and an increased length of service. Functional measures showed a 199% increase in the 11 functional areas when averaged. Fidelity testing showed an average of 72% fidelity to the revised MISA services model. This study concludes that improved access to MISA-specific services significantly increases these consumers' quality of life.

Publication types

  • Comparative Study

MeSH terms

  • Diagnosis, Dual (Psychiatry)*
  • Efficiency, Organizational / statistics & numerical data
  • Health Services Accessibility / organization & administration*
  • Health Services Research
  • Humans
  • Illinois
  • Mental Disorders / diagnosis
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Mental Health Services / organization & administration
  • Mental Health Services / standards*
  • Models, Organizational
  • Organizational Case Studies
  • Outcome and Process Assessment, Health Care
  • Quality Assurance, Health Care / methods*
  • Self Efficacy
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / psychology
  • Substance-Related Disorders / therapy*