The Climb to Know More About Dual Diagnosis: Insights from Marge Brown
The Climb to Know More About Dual Diagnosis
Speaker: Marge Brown
When Marge Brown opened her presentation with a story about climbing fences and exploring an abandoned institution in Puerto Rico alongside Gentle Teaching founder John McGee, the room instantly knew—this wasn’t going to be your typical clinical talk. And it wasn’t. What followed was a deeply personal and profoundly educational journey into the world of dual diagnosis, where intellectual and developmental disabilities (IDD) meet mental health needs.
From Institutions to Inclusion—and the Gaps That Remain
Marge spent decades supporting people with complex needs—especially those moving out of institutions and into community life. Her career has taken her across the United States, always with one purpose: to serve the individuals “no one else would take.” She saw firsthand the trauma that institutional living created, and how communities struggled (and still struggle) to respond meaningfully to those with both IDD and mental health challenges.
Today, Marge works with Merakey, a large organization in the U.S. that offers services across 12 states. She’s also a certified Dual Diagnosis Specialist through the National Association for the Dually Diagnosed (NADD), a growing movement in the U.S. that aims to close the care gap for people living with both IDD and psychiatric conditions.
Why Dual Diagnosis Matters
“Looking back, I now realize that nearly everyone I supported coming out of institutions had a dual diagnosis,” Marge shared. “We just didn’t have the language or systems to name it.”
Historically, mental health and developmental services were siloed. A person either “belonged” in one system or the other—but never both. This resulted in fragmented care, misdiagnoses and a whole lot of unmet needs.
Now, we know better. According to NADD, over 1 million people in the U.S. live with dual diagnoses. These individuals often face complex medical, emotional and behavioral challenges. Yet caregivers and families are still too often left without the knowledge or resources to understand what’s really going on.
Breaking the Myths: It’s Not “Just the Disability”
One of the most common mistakes Marge highlighted is this: assuming that behaviors are “just part of the disability.” In reality, many of these behaviors are rooted in unaddressed mental health needs, trauma, or neurological differences.
And the signs can be subtle. For instance, individuals with certain genetic syndromes may:
- Learn best in step-by-step formats (e.g. Down syndrome)
- Be highly sensitive to noise or touch (e.g. Fragile X)
- Struggle with pain recognition (e.g. Smith-Magenis Syndrome)
Understanding those patterns—known as genetic phenotypes—can be essential to providing the right care. As Marge emphasized, “You can’t support what you don’t understand.”
Behavior Management vs. Healing Relationships
Marge was candid about the outdated and harmful practices she’s seen over her career—including behavior plans that used rewards, punishments, or even physical takedowns. She pushed back hard against those models, choosing instead to build trust through Gentle Teaching, a philosophy rooted in creating safe, loving, and engaged relationships.
“People aren’t German Shepherds. You don’t train them with cookies and commands,” she said to laughter from the room—but her message was serious.
Through Gentle Teaching, the focus isn’t on controlling behavior—it’s on understanding the person: their trauma, their communication style, their sensory world and what makes them feel safe.
The Power of a Clinical Team with a Human Heart
At Merakey, Marge is part of a multidisciplinary clinical consultation team that includes psychiatrists, psychologists, behavior specialists, and trainers. Each month, they review complex individual cases from across the agency. The team looks at:
- Medical history and medications
- Psychiatric diagnoses
- Sleep, sensory needs, sexuality, trauma
- Risk assessments and quality of life
They don’t just review files—they listen to each other, collaborate, and share strategies. And next month, they check in again. “It’s like Grand Rounds, but for real people with real lives,” Marge said.
Training That Reflects the Whole Person
Marge also shared the growing emphasis on certification and training for professionals working with people who are dually diagnosed. The National Association for the Dually Diagnosed (NADD) now offers three certification paths:
- Clinical Certification – for psychiatrists, psychologists, and licensed professionals
- Specialist Certification – for professionals like Marge working in support and education
- Direct Support Certification – for frontline caregivers, with a focus on observation, communication, crisis prevention, and teamwork
And here’s the beautiful part: when Marge completed her specialist certification interview and spoke about Gentle Teaching, the evaluator stopped her mid-conversation and said, “You’ve already got it.”
Safe. Loved. Loving. Engaged. Always.
Despite all the new research and systems, Marge reminded us of one central truth:
“John McGee knew all the mental health diagnoses. But he kept Gentle Teaching simple—because it works for everyone. No matter your background or training level, Safe, Loved, Loving, and Engaged is something we can all understand.”
It’s not about labels. It’s not about silos. It’s about recognizing each person’s humanity and supporting them with care, curiosity, and connection.
Want to Learn More?
- Merakey Clinical Consultation Services are available to other agencies across the U.S.
- The National Association for the Dually Diagnosed (NADD) offers certification, training, and resources.
- Marge Brown is always happy to connect!
Whether you’re a caregiver, family member, professional, or simply someone who cares, Marge’s message is clear: never stop learning. The climb to understanding dual diagnosis is steep—but it’s worth every step.