Individuals with co-occurring mental health and substance use disorders have been identified as a distinct group with special service needs. It is widely acknowledged that neither the mental health system nor the substance abuse system is well organized to address the special service needs of this group. These individuals often tend to fall through the cracks, resulting in an over-utilization of resources in criminal justice, primary health care, child protection, as well as women's and homeless shelter systems. There is growing research evidence that individuals with co-occurring disorders represent a significant proportion of clients that appear in both mental health and addiction service settings. Experts now emphasize that the presence of this group in both systems should be treated as an expectation, rather than an exception and should be addressed accordingly.

Following a review of the best practice literature, a local multi-agency planning committee (with consumer involvement) concluded that the needs of these individuals must be acknowledged and addressed across service settings in both systems. The combined system should offer a comprehensive array of services delivered in a coordinated and continuous fashion - a system where there would be NO WRONG DOOR. A long-term systems change project that would result in comprehensive, continuous, integrated service delivery for persons with co-occurring disorders was recommended and subsequently approved.

Following project approval, a Winnipeg CODI Leadership Team hired international consultants, Dr. Kenneth Minkoff and Dr. Christie Cline. The principles and implementation process they recommended for development of a Comprehensive, Continuous, Integrated System of Care (CCISC), were adopted. Much of the activity of the first year centred around a training-of-trainers and systems change consultation process supported by Drs. Minkoff and Cline. Over the span of 10 months, a small group of local clinicians from a variety of local mental health and addiction service programs participated in 10 days of change agent training. During this period, participating agencies also began to develop and implement organizational action plans that would move both systems (MH and Addictions) toward a more coordinated and integrated service system.

Manitoba CODI
Whereas the Winnipeg project addresses systems change within the geographic area served by the WRHA, in the spring of 2003, Manitoba Health and AFM invited the 10 other regional health authorities from across Manitoba to join them in a cooperative initiative that would extend the project implementation province-wide. This phase of the Initiative is currently in its formative stage.