What’s Needed in a Treatment System for People with
Mental Illness and Chemical Dependency
FOCUS GROUP REPORT
2003
The Mental Health Consumer/Survivor Network of Minnesota (CSN), under contract
with the Minnesota Department of Human Services, Mental Health Division, conducted
forty-four (44) focus groups statewide. The groups included mental health consumers
who receive MI/CD (mental health/chemical dependency) services. All those who
participated have a serious mental illness and are chemically dependent and are working
very hard at recovery.
The purpose of this study was to get a sense of what mental health consumers want in an
integrated MI/CD service system and also, what their experience has been in the mental
health service system. Twenty focus groups were conducted in the seven county
metropolitan area. Twenty-four focus groups were held in the non-metro area.
Participants were volunteers and were not randomly chosen.
Major themes emerged from the groups, including:
• positive comments about peer support groups and the difficulty in accessing
these groups in rural areas
• positive comments about an MI/CD program at the Willmar Regional
Treatment Center
• lack of cross training between MI and CD staff
• the stigmatizing between CD workers and the consumers
• MI workers appear to be more sympathetic toward individuals with mental
illness and chemical dependency than CD workers
• budget cuts and the effect on services
An integrated service system would include, according to all focus group attendees:
• peer support
• providers who are crossed trained
• more psychiatrists
• more halfway houses or crisis houses – as many in the community as possible
• education on MI/CD for staff, families and the general public
Focus group process
The facilitators of the focus groups were consumers employed by the CSN. They
attended an all day (6-hour) facilitator training that included a role play of a focus group
and concluded with a critique of each facilitator by other facilitators.
The CSN contacted MI/CD or Dual Recovery self-help groups, CSPs, Day Treatment
programs, drop-in centers, group homes, detox services and other facilities to ask for
participants. The only qualification for participation was that the individuals have both
mental health and chemical dependency problems. (Participants were not chosen
What’s Needed in an MI/CD System
Report on Focus Groups Conducted by CSN – 2003
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randomly.) Attendees filled out a consumer questionnaire and then, with the group,
answered specific focus group questions.
Consumers in twenty-seven (27) counties were surveyed. Each of the Mental Health
Initiatives was covered. Multiple focus groups were conducted in the following counties:
Hennepin (8), Ramsey (4), Dakota (3), Anoka (2) and Pennington (2). A total of 212
consumers participated.
Participant Characteristics
The demographic characteristics of the focus group participants are shown below. The
majority of the participants were male, white and between 41 and 50 years of age.
GENDER
Male
Female
Focus Groups
122
57.5%
90
42.5%
RACE/Ethnicity
White
African-American
American Indian
Latino/Hispanic
Asian
AGE
18-20
21-30
31-40
41-50
51-64
65+
165
27
11
5
4
77.8%
12.7%
5.2%
2.4%
1.9%
3
35
48
87
38
1
1.4%
16.5%
22.6%
41.0%
17.9%
0.5%
Responders have had the following experiences:
Been in jail
128
60.4%
Treated for both MI and CD at last treatment
118
55.7%
Used alcohol or other drugs with prescription
medications in last 6 months
82
38.7%
Metropolitan Area Focus Groups (7-county)
Of the twenty focus groups held in the seven county metropolitan area fifteen (15) cited
housing as a major need. Employment was considered by 18 groups as a
recovery tool. Fourteen of the groups talked at some length about the length of the
programs. All believed they were too short, there was no follow-up once the actual
program ended and if there was aftercare, it was minimal. Within these groups, strengthWhat’s Needed in an MI/CD System
Report on Focus Groups Conducted by CSN – 2003
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based system was consistently mentioned. These 14 groups felt strongly that the current
system for MI/CD was deficit-based, and this is what the providers focused on.
Nine groups mentioned the lack of cross training between providers in the mental health
and chemical dependency fields. They often mentioned that they felt like they were
being tossed back and forth between the two, with no on knowing what to do to help.
Nine groups commented positively about the Fairview treatment program. It was
described as being “really integrated” and “helped me to regain my life.”
Six focus groups, all located within Hennepin County, talked about the MI/CD program
at the Lighthouse. Comments were made by the groups that the program was
“successful” and that “people can come when they need to.”
Ten focus groups felt that the CD workers were more stigmatizing toward individuals
with a mental health diagnosis than mental health workers were towards those with a
chemical dependency diagnosis.
All twenty focus groups talked at some length about peer support groups. All agreed that
there was a definite need for more of these groups that met at a variety of times and days.
The peer support groups that do exist received positive comments; it is a matter of
quantity. Transportation came up as a major issue in assuring attendance.
Non-metro Area Focus Groups
Outside the metropolitan area, twenty of the focus groups talked about employment as a
major concern. Working kept many from drinking and on their medications. Consensus
was that self-esteem was linked very strongly to employment. As in the metropolitan
area, transportation was a large concern. Distances often make employment difficult.
Availability of clean and safe housing was linked to employment. Eighteen groups
mentioned this as a must for recovery and returning to the community.
Ten groups talked about the lack of cross training of mental health and chemical
dependency providers.
Seventeen groups reacted positively to the MI/CD program at the Willmar Regional
Treatment Center. Comments ran along the lines of “staff really good” and “they
understood both mental illness and chemical dependency.”
All twenty-four groups talked about the lack of aftercare. Help just wasn’t available after
the initial programs were completed. Due to the lack of aftercare, hospital stays were
longer because there was no place to go in the community. The agreement on this
concern was strong and evident throughout the twenty-four groups in the non-metro area.
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Report on Focus Groups Conducted by CSN – 2003
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Similarities between Metropolitan and Non-metro Area Focus Groups
Lack of aftercare was a common theme for all forty-four focus groups. As one person
said, “Some programs make you do your own footwork in getting aftercare.” Another
person said, “Aftercare is not funded. It would be cheaper and better for individuals than
the revolving door of crisis intervention.” Nearly half (20 focus groups) talked about the
need for a crisis facility in the community where an individual could stay for two days.
Budget cuts and the potential for cuts in services were talked about by all forty-four
groups. There was a lot of uncertainty surrounding this issue and a feeling of
helplessness.
Forty groups said that the police and/or sheriff’s departments needed more training in the
MI/CD area. The use of handcuffs and being driven away with lights and sirens was
mentioned consistently in both the metro and non-metro areas, as being de-humanizing.
The non-metro focus groups talked about the stigma that this caused in their small
communities and how this made it very difficult for them to return home.
All forty-four groups talked at great length about peer support and one-to-one support.
There was consensus that while the groups that currently existed worked well, there
weren’t enough groups. Transportation surfaced as a major barrier, both in the metro and
non-metro area of the state. Halfway houses for those who could be released from the
hospital, but were not quite ready to be on their own, was also mentioned across the
board as a missing piece in the system.
The need for more psychiatrists was evenly split between the two areas of the state: eight
focus groups in the metro and eight in the non-metro agreed that this was a concern.
Another area that was evenly split (seven and seven) was the need for greater education
on MI/CD for staff, families and the general public.
Major Issues
Overall the comments of the participants illustrated that except for a few selected
programs (Willmar, Fairview and The Lighthouse) the MI/CD system was not an
integrated system. The comment “They are totally different systems” sums up the
opinion pretty well from all over the state.
Housing and employment were linked over and over again. Both were viewed as
recovery tools. One person said, “Housing has made recovery possible. You have to
hang around healthy people.” Safe, affordable, clean housing was repeated over and over
again in all areas of the state. There is a general lack of both (housing and employment)
in all parts of the state, according to comments from all forty-four groups.
Peer support, either in groups or one-on-one, was talked about as the best hope for
continued recovery. “We need more support groups and drop-in centers for dual
diagnosis. Groups are important. Peer specialists would be great.”
What’s Needed in an MI/CD System
Report on Focus Groups Conducted by CSN – 2003
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