First of all, it's worth noting that about three-quarters of people who seek addiction treatment have a prior mental health history. There is an important relationship to note between these. Again, it's just a common thing, so one of the realities we can speak about is that people with co-occurring disorders and who are in the general health care system are more likely to seek help, but we do a worse job of retaining them in treatment and they have poorer outcomes.
So again, one of the problems we have is systems of care that really don't do a good job of addressing complexity in terms of being able to engage people and retain them. Where we're coming from generally is a bit of a disadvantage. We know that when we can offer integrated programs of care with people--and there has been some important research done, particularly with people with severe mental illness and addiction--we do have better treatment engagement and better long-term outcomes.
The interesting thing about some of this research is that the programs that have worked with individuals with severe mental illness and addiction have needed periods of time of up to five years to be able to demonstrate the efficacy of the treatment. If these are long-term interventions with people with chronic problems, you usually don't show an immediate effect. You need time. Then you can demonstrate an effect.
In Ontario, for example, in the 1990s when, for a variety of reasons, there were some reductions in health spending, the government of the day actually--it was a Conservative government--invested actively in ACT teams, assertive community treatment teams, which offered integrated treatment for people with serious addiction and mental health problems. The important thing about it was that the economics were suggesting that by making that investment they were saving money in other ways.
So generally, the advice for people with co-occurring addiction and mental health problems is to have strategies that offer integrated care. There is a high level of confidence that when you do that, even though it requires a particular kind of investment, you produce savings in a whole bunch of different sectors, not just in the health care sector, but in terms of criminal justice and a variety of areas across a person's functioning.