Changing the System for Mental Health and Addiction in Delaware

Deaths of despair–from suicide, opioid overdose, and alcohol use–have been at an all-time high for the decade leading up to the pandemic–and skyrocketed during the pandemic by 23%. The state of Delaware had one of the top 5 rates of death of despair in the nation. In addition, Delaware like all states across the nation have a long history of criminalizing people with mental health and addictions, especially in communities of color. Delaware has a 15% higher absolute rate of criminalization of people of color than other states.

Why Does this Challenge Exist?

Financial insecurity, hopelessness for a better future, social isolation, all contribute to deaths of despair–along with the availability of street drugs like fentanyl which can lead to accidental overdose.

Who Came Together?

The Delaware Division of Substance Abuse and Mental Health (DSAMH)
Delaware Department of Public Health (DPH)
Delaware Division of Child Services
Delaware Division of Services for Children, Youth, and their Families
Delaware Department of Corrections
Delaware Medicaid
Health Management Associates (technical assistance partner)
Wellbeing and Equity (WE) in the World (strategy and technical assistance partner)
Community partners (schools, businesses, health care providers, etc.)

The Role of WE in the World

Supported DSAMH team to develop and implement a multi-sector system change strategy to improve the well-being and lives of people living with mental health and addictions challenges

What Changed

Care transformation for those at highest and rising risk

Changing culture and policies in policing and justice systems to transform addiction and incarceration pipelines into pathways of opportunity

Prevention and Planning ahead for people aging with mental health and addictions


  • Decreased the number of people reported suffering with mental health and addictions
  • Decreased the percentage of people who self-reported that they were suffering on Cantril’s ladder from 25% to 5%, n = 8,423
  • Overdose rate increased only 3.6% in Delaware in 2020 (compared to a national average of 23.2%)

How We Did It

Approach & Building Blocks

No wrong door access approach – meet people wherever they were at

Connection/realtime information exchange
D-TRN – closed loop information system to connect and refer people to services across sectors with information back about disposition

Stories to System Change – to identify how existing systems were serving people with mental health and addictions well–and where they were failing them–across sectors and over the course of someone’s life

Key Insight


And Failings Forward

System transformation designed from the experiences of real people could lead to major changes in health and life outcomes within a relatively short period of time (2-3 years).

Political sustainability matters - Eventually, political and leadership changes led to a dismantling of these systems. Rates and incidents and deaths of despair rebounded.

“Until we could understand the system from the stories and lives of people going through the system, until we could understand how these systems were connected and working together to serve or fail people with mental health and addictions, we couldn’t change them”

– Elizabeth Romero, Division Director of DSAMH, 2019


Framework and tools to strategically advance health equity for public health change agents

The WIN Measures is the first set of national measures for improving health, equity, and vital conditions. These measures are applicable across sectors and initiatives.