Mental illness and substance abuse: implications for women's health and health care access

Individuals with serious mental illness (SMI) and/or alcohol and other drug (AOD) problems often have physical health concerns that are not appropriately treated and that interfere with effective management of SMI and/or AOD problems and contribute to the overall costs to society of these disorders. Although the literature has limitations, available evidence suggests that women with SMI and/or AOD problems have more numerous and severe health concerns than comparable men and that they receive less appropriate health care than men do. These greater problems relate directly to SMI or AOD use, or involve difficulties in complying with medical regimens, side effects of medications, or interactions of AOD use and SMI with other health conditions. Individuals' life situations can also increase their vulnerabilities and health risks. Health problems frequently are not detected by specialty or general practice health professionals, and thus get worse. Women with SMI and AOD disorders have less access to appropriate physical health care services--both within the AOD and SMI treatment systems and within health care settings. Recommendations for improved health care for highly stigmatized groups of women with multiple needs include stronger linkages between systems, increased training of health providers, and policy and program changes.