To facilitate service integration, there need to be integrative policies and administrative support at the system level.  State, county, and local mental health authorities either promulgate, or are bound by, financing mechanisms and regulations that impede integrative service delivery.  In most states, for example, licenses for mental health and substance abuse facilities are handled by two different state agencies with separate regulatory, financial, and oversight procedures.  Frontline providers are often caught between doing what is clinically indicated and what is financially reimbursable with the dual diagnosis client suffering the consequences of ineffective care.  New interorganizational structures and policies are required to enable the seamless provision of requisite services.  These structural changes do not necessarily require more resources, and integration has the potential to be cost efficient. ^[1]  

Advocates and practitioners agree that much can be done at the systems level to remove impediments and ease the provision of integrated mental health and substance abuse services. Supported by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) in June 1998, the National Association of State Mental Health Program Directors (NASMHPD) and the National Association of State Alcohol and Drug Abuse Directors (NASADAD) conducted a formal dialogue intended to explore the issues related to the provision of integrated services. A report on this dialogue was issued by the two organizations in March 1999.  In signaling their desire to collaborate in finding solutions, they have initiated a process each hopes will bring movement at both the federal and state levels. ^[2]   More recently, the SAMHSA work plan for 2002 and beyond gives the highest priority to addressing the issues involved in providing services for people with co-occurring disorders. ^[3]  

It is not surprising that financial questions are among the thorniest facing policymakers seeking integration of substance abuse and mental health services. For example, the federal Substance Abuse Block Grant and Mental Health Block Grant are separate funding streams administered in different centers within SAMHSA. They often flow to different agencies in a given state and, in turn, finance quite different providers and services at the community level. Because integration of such federal funding brings with it the possibility of a significant realignment of resources throughout the system, many who would be affected are moving towards integration with great caution.

It should also be noted that the use of illicit drugs - and, more specifically, arrest for drug-related crimes - may result in limitations on an individual's ability to receive important federal benefits such as SSI or to qualify for housing under many public housing programs. Because of the high prevalence of co-occurring substance abuse and mental health disorders, many of those who come into contact with the criminal justice system are people whose past activities have left them unable to access various federal benefit programs.  This circumstance places an additional strain on state systems and local agencies seeking reimbursement for integrated services provided to people with co-occurring disorders.