Managing substance use for clients with serious mental illnesses: Knowledge, attitude, and training challenges among outpatient behavioral health providers in California, Ohio, and New York.

Purpose: Individuals with serious mental illness have high rates of substance use. The most commonly used substances among this population are alcohol and cannabis, and whether clinical providers delivering mental health services feel adequately prepared to address substance use is unclear. While information about the effects of alcohol are well established, the effects of cannabis are less well known and staff may feel less confident in their abilities to assess its use and may rely on more informal sources to learn about it.

Methods: Mental health agencies in three states (California, Ohio, and New York) surveyed their staff (n =717) to explore their knowledge, training, and expertise in assessment of substance use generally as well as cannabis and alcohol specifically.

Results: Overall, providers felt more prepared to address their clients' alcohol use than cannabis use. In between-state comparisons, California providers felt significantly less well prepared to assess, discuss, and refer their clients to treatment compared to Ohio and New York providers. Using a series of multi-categorical mediation models, we confirmed that deficits in training for these specific substances largely accounted for between-state differences in assessment, capacity, and treatment.

Conclusions: Substance use training to address the service needs of individuals with co-occurring disorders is insufficient and a significant need exists for systemic changes to workforce training of community mental health providers.