Services for perinatal women with substance abuse and mental health disorders: the unmet need.

Dual diagnosis refers to the co-occurrence of substance abuse and mental illness, which may take many forms. Women who abuse alcohol or drugs are more likely than men to be diagnosed with a psychiatric disorder, particularly depression or personality disorder. The interaction of pregnancy, addiction, and mental illness creates complex needs that often go unrecognized by treatment providers. Clinical issues concern adequate prenatal care, use of medications while pregnant and/or nursing, maternal bonding, and coordinated treatment planning among medical, addiction, and mental health treatment providers. Barriers to service delivery to perinatal substance-abusing women with a mental illness include the difficulty in diagnosing a dual disorder, child care and custody concerns, lack of health insurance or funds to pay for treatment, and the stigma associated with mental illness and addiction. Services currently available for the dually diagnosed are typically fragmented and uncoordinated and provision of those services is often hampered by philosophical differences, categorical funding, competition for scarce resources, inadequate staff training, and lack of a central administrative authority or mandate. Several models have been suggested that coordinate services for the dually diagnosed. Awareness of the service needs of dually-diagnosed perinatal women must be included within these models and integrated at all levels of the treatment system.