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CAUT Bulletin Archives

May 2006

Psychiatric Cross-Training Needed to Treat Concurrent Disorders

Harald Urstad
It is becoming clear from studies published over the last 20 years that mental health and substance use disorders occur more frequently together than as separate entities. Yet most educational institutions offer very few courses that deal with these issues from an interdisciplinary perspective.

The medical, behavioural and social sciences are severely limited in educational opportunities about substance use disorders, and they hardly ever offer anything dealing with the fact that most clinical conditions almost never exist in isolation from other problems.

Philosophical and ideological barriers between faculties and departments feed on the preservation of their biases. They often ignore the expertise of other professions. Whether this is due to ignorance, fear of the unknown, lack of a common language or competition for resources and the preservation of their professional identities may differ from place to place. But the bottom line is that students are ill prepared to deal with the complexities of most clinical conditions in an interdisciplinary manner that may lead to new trans-disciplinary undertakings.

It is well established in the literature that substance misuse is directly or indirectly the cause of multiple disorders, maybe even the majority of problems treated in our systems of care. Most post-secondary schools don’t pay much attention to this in their curricula. At best, the odd course is offered as an elective. This, while most international best-practice guidelines recommend the inclusion of substance misuse, mental health and interdisciplinary cross-training as a prerequisite for evidence-based teamwork and care.

In the 1990s I wrote about some of the challenges and of my early thinking about the interdisciplinary and cross-training needs in psychiatry with specific reference to program management in that field.1 More than a decade later very little has changed, although the evidence for this approach has increased significantly across the national and international systems of care.

The challenge is not limited to Canadian educational institutions, but has also been identified across the western world as an important next step in preparing students for the complexities of new trans-disciplinary initiatives and clinical work that provide comprehensive evidence-based care.

Universities and colleges should be at the forefront, promoting and encouraging educational pathways based on recent scientific evidence.

1 Urstad, Harald. “Consumers Call the Shots on Health Care Delivery.” CAUT Bulletin, September 1994.

Harald Urstad is a psychologist teaching in the substance abuse program at the University College of the Fraser Valley in British Columbia who has advocated the setting up of a concurrent disorders program at UCFV. He is also a healthcare consultant to organizations and health regions dealing with substance use and mental health challenges.

The views expressed are those of the author and not necessarily CAUT.