How to Foster Continuity of Care

Hospitals and community-based organizations should collaborate more closely with one another. This may include standardization of information and shared electronic health records.

Providers and mental health organizations should use treatment-performance standards as part of a quality-improvement approach that can enhance treatment continuity.

All mental health consumers should receive care management for transition from hospital to community; care-management services should be reimbursable by all payers, and the disincentives to providing them should be removed.

Mental health agencies should focus on the “pull model” of transition from inpatient to outpatient care, which emphasizes involving community-based providers in the transition process.

Accreditation standards should be aligned to address and improve continuity of therapy in treating mental illness.

Consumers and their families should be educated about the benefits of maintaining their medical histories, whether through written logs or portable electronic devices.

Consumer-driven recovery planning should include the appropriate use of hospitalization. More thoughtful use of inpatient services can lead to a reduction in emergency-room use and a decrease in number of hospitalizations.

Payers who collect data about mental health services and performance should share the data with appropriate stakeholders to enhance the provision of care.

Consumers and mental health advocates should be involved in all levels of system delivery and evaluation. Examples include using peer specialists as part of a treatment team and involving them in the development and implementation of performance-evaluation measures. ▪