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Often times a mental illness isn’t the only concern for patients needing treatment. Referred to as a dual diagnosis, patients can experience mental illness with a multitude of other conditions, from development disabilities to alcoholism to abusing drugs.

One-third of those with a mental illness present a dual diagnosis, according to data from the National Alliance on Mental Health, a nonprofit advocacy group. The organization says roughly half of substance abusers report experiencing a mental illness.

In those instances of drug use along with a mental illness, patients become inherently more difficult to treat. The CROSS Region’s disability service coordinator Angela Nelson said substance abuse beds are even harder to come by than mental health beds.

With legal commitments, they can go the route of a mental health commitment or a substance abuse commitment. The facility or program a patient is then referred to varies depending on the commitment type.

“That’s where family members really get into that quadrum of when they go to do a commitment…do they do a substance abuse commitment or do they do a mental health commitment?” Nelson said. “When you do a substance abuse commitment, there are no beds for substance abuse. It is full.”

However, sending someone with drugs in their system to a mental health bed isn’t necessarily a good option, either.

“They’re trying to detox,” Nelson said. “They’re not working on any mental health [issues].”

NAMI says in order for the dual diagnosis to be treated properly, a patient first must go through inpatient detoxification, a process they say can take up to seven days. Then care for a mental illness can occur.

Marion County Sheriff Jason Sandholdt says they are two separate issues that need to be looked at together, then treated separately.

“I think a lot of times people have both issues,” he said. “I think a lot of times, mental health issues leads to substance abuse issues.…I think you have a lot of people with mental health issues that end up getting addicted.”

NAMI Iowa executive director Peggy Huppert said those with a dual diagnosis, or complex needs, aren’t an anomaly, but instead are a common occurrence.

“They’re people who have a serious mental health diagnosis, but also have a developmental disability, they might have substance abuse problems, and they might have a history of violence,” Huppert said. “And if if you combine anyone of those with a serious mental illness, you make it much, much, much tougher finding placement for that person.”

Formerly, there was a treatment facility that could handle those patients. It was the state-run facility in Mount Pleasant that was shut down in 2015 via a line-item veto by Gov. Terry Branstad.

“The state previously had the only co-occurring condition treatment center was at Mount Pleasant, and that was shut down…and not replaced,” Huppert said.

Huppert said that state beds like what was once offered by Mount Pleasant could play a part in solving the issue. She said in recent times these beds are where the dual diagnosis population was served.

“Where state beds could come in very handy is to accept this population of patients that private providers do not want to accept,” Huppert said. “But what has happened is that, the state institutions stopped accepting them as well.…Frankly what’s happened is, they end up in jail, in prison, homeless, or at home with their parents who are trying to cope. And, in at least a few cases in Iowa recently have ended up getting killed.”