Historically, medical care, mental health care and substance abuse treatment have been provided by distinct agencies and programs. There can be inefficiencies or even risks with this type of multi-track care. For vulnerable populations (including individuals returning to the community from incarceration) who need to locate and organize a host of personal needs ranging from employment to child care, the need to juggle multiple providers can be a severe barrier to obtaining treatment. ^[1]   Minimizing the number of referrals and providers-or their geographic dispersion-is one way to address this hurdle.

When it is not possible or appropriate to consolidate treatment, providers should strive to coordinate their care. Since a patient's separate, uncoordinated providers typically do not share medical information with each other, prescribing physicians may not know what medications or treatments have been prescribed by other providers and thus may prescribe medications that have adverse effects or result in dangerous drug interactions. Citing valid patient privacy issues, mental health agencies and substance abuse treatment programs have been especially resistant to such communication. Yet many patients would derive great value from information-sharing among their care providers. Various jurisdictions have devised strategies for sharing information legally, some as simple as obtaining a valid waiver from a patient who has been informed of his or her right to privacy for medical information. Physical health, substance abuse, and mental health specialists should not, therefore, simply assume that confidentiality restrictions summarily preclude them from coordinating or consolidating their care with other providers. Indeed, agencies that fund any of these programs should assure that their funded programs maximize appropriate clinical communication among the various providers of medical care, mental health care, and substance abuse treatment, while respecting the rights of patients to keep their personal information private. (See Policy Statement 8, sidebar, "Regulations Regarding Confidentiality," for more on federal privacy requirements.)