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Adult coordinated service

Mental Health Intensive Community Model

Intensive community-based support for serious mental illness with access to SUD expertise and treatment.

Coordination note · verify locally

Confirmed public source

Why SUDS Outpatient Involves This Service

Intensive community support can stabilize serious mental illness, improve engagement, and connect patients to SUD expertise while preserving specialty addiction care.

Common Involvement Triggers

Serious mental illness with high service use, functional impairment, engagement barriers, or community-support needs that exceed routine outpatient care.

Shared-Care Responsibilities

Define community-team, SUDS, pharmacy, nursing, risk, housing, and rehabilitation responsibilities and avoid duplicate medication changes.

Handoff Essentials

Provide the longitudinal problem, service-use pattern, functional and engagement barriers, SUD treatment, medications, safety needs, and requested intensive support.

Continuity and Return Plan

Use a shared plan for medication changes, outreach, risk escalation, SUD goals, and transition when intensive-community criteria no longer apply.

Operational Boundary

Confirm current eligibility, capacity, consult names, schedules, contacts, and transfer procedures in approved VA systems.

Publicly Confirmed Sources

These links establish public context; they do not establish current local availability or workflow.