title: Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health Service.
abstract: OBJECTIVE
  In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co-morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co-morbid D&A and mental health disorders.
  
  
  METHODS
  Current literature on co-morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision.
  
  
  METHODS
  A rural Area Health Service in NSW.
  
  
  METHODS
  Rural health and welfare service providers, consumers with co-morbid D&A and mental health disorders.
  
  
  RESULTS
  Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug-taking. Information gathered from the focus groups indicated a reasonable level of awareness of co-morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources.
  
  
  CONCLUSIONS
  Significant gaps in the provision of appropriate care for people with co-morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co-morbid care can be provided.
authors.affiliation: Centre for Rural and Remote Mental Health, University of Newcastle, New South Wales, Australia. bryan.hoolahan@newcastle.edu.au
authors.forename: Bryan
authors.initials: B
authors.lastname: Hoolahan
authors.forename: Brian
authors.initials: B
authors.lastname: Kelly
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Stain
authors.forename: Didi
authors.initials: D
authors.lastname: Killen
mesh_terms: D015897:Comorbidity; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D009517:New South Wales / Q000453:epidemiology; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000379:methods; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*