Individuals with co-occurring serious mental illness and substance use disorders experience a highly fragmented system of care, contributing to poor health outcomes and elevated levels of unmet treatment needs. Several elements in the health care reform law may address these issues by enhancing the integration of physical and behavioral health care systems. The purpose of this paper is to analyze these elements, which fall into three domains: increasing access, restructuring financing and reimbursement mechanisms, and enhancing infrastructure. We conclude with a consideration of the implementation challenges that lie ahead.

Results demonstrate that job accommodations show potential to improve employment outcomes for individuals with psychiatric disabilities receiving supported employment services, indicating that job accommodations should be stressed in policy and continuing education efforts for program staff and clients.

By reducing the need for inpatient and emergency services for some individuals, peer respites may increase meaningful choices for recovery and decrease the behavioral health system's reliance on costly, coercive, and less person-centered modes of service delivery.

No abstract

Peer respites are voluntary, short-term, residential programs designed to support individuals experiencing or at-risk of a psychiatric crisis. They posit that for many mental health services users, traditional psychiatric emergency room and inpatient hospital services are undesirable and avoidable when less coercive or intrusive community-based supports are available. Intended to provide a safe and home-like environment, peer respites are usually situated in residential neighborhoods. These programs are increasing in number across the United States, yet there is very little rigorous research on whether they are being implemented consistently across sites, and what the processes and outcomes are that may lead to benefits for persons experiencing psychiatric crises and to overburdened mental health systems. In this Open Forum, we present an agenda outlining implementation and research issues faced by peer respites.