Areport from the Institute of Medicine (IOM) of the National
Academies offers a first-time comprehensive strategy to improve health care
for people with mental illness and alcohol or drug problems by linking them
with high-quality care in the overall U.S. health system.
The report, called "Improving the Quality of Health Care for Mental
and Substance-Use Conditions," was released last month and outlined key
roles for government officials, clinicians, health care organizations, health
plans, and insurance purchasers.
The authors found that, as with general health care, the delivery of
high-quality interventions is inconsistent, and poor care has serious
consequences that range from lost productivity to suicide. The private and
publicly funded report found that more than 33 million Americans use health
care services for mental health and substance abuse treatment annually, and
that successful, cost-effective treatments exist.
"To the extent that we fragment care between general health care and
mental health services we reduce the overall effectiveness of health
care," said Paul Appelbaum, M.D., chair of the Department of Psychiatry
at the University of Massachusetts and a member of the committee that prepared
the study, in an interview with Psychiatric News.
Health services for mental health and substance abuse conditions have been
isolated not only from other components of the health system but also from
each other, Appelbaum said, despite the fact that many people have psychiatric
conditions, including problems with alcohol or drugs.
The report's recommendation for a "multidimensional approach"
goes beyond previous research findings that have focused on service
improvements that could be made to various components of mental health,
substance abuse, and general health care, Appelbaum said.
To make collaboration and coordination of care the norm, service providers
should link relevant areas of their own organizations and form ties with other
providers, said the report.
The report encourages government agencies, purchasers, health plans, and
accrediting groups to create incentives and policies to increase collaboration
among all health care providers. The Department of Health and Human Services
(HHS) should lead these efforts by establishing a permanent, highlevel
mechanism to foster greater coordination across the department's mental,
substance use, and general health care agencies.
A broad range of providers licensed to diagnose and treat mental illnesses
and substance abuse has spawned varied training levels and therapeutic
approaches. The result is that the overall workforce has an uneven
distribution of the knowledge and skills necessary to provide consistent,
high-quality services, according to the report.
While the report specifically avoided identifying models of better
integration, Appelbaum said, it requested that Congress authorize and fund a
component called the Council on the Mental and Substance-Use Health Care Work
Force to create plans that help professionals improve the quality of the care
"The quality-of-care movement in health care has been late in coming
to mental health, but it is revolutionizing how people think about delivering
those services," Appelbaum said.
Effective care also hinges on the ability of health professionals to obtain
and share information quickly on a patient's health and potential treatments,
the report said. It urged federal and state governments to revise laws,
regulations, and administrative practices that hinder such information
Among the few potential drawbacks to the systemic changes advocated in the
report, Appelbaum said, are possible abuses that come with increased access to
patient information. But the technological safeguards exist to control this
risk, he said.
An information technology system under development, called the National
Health Information Infrastructure (NHII), will make the exchange of health
information easier. But such efforts have dealt inadequately with health care
for psychiatric problems, including substance use, said the report. It urged
HHS and the Department of Veterans Affairs to take steps to ensure that NHII
will comprehensively address such conditions. Additionally, federal and state
governments, purchasers, and foundations should offer incentives to clinicians
and groups who treat these problems to invest in the information technology
needed to fully participate in NHII.
The report called for HHS to gather and disseminate scientific evidence on
effective services for mental and substance-use conditions. The department
should lead efforts to develop an infrastructure to measure and improve the
quality of mental health care, including treatment for substance use. It
encouraged HHS to work with the private sector to create a private, nonprofit
organization able to identify and put into practice quality measures in these
Charles Curie, M.A., administrator of the Substance Abuse and Mental Health
Services Administration, said in a statement on the IOM report that his agency
intends to work within HHS and other agencies and organizations to"
expand capacity for treatment that is science based, responsive to the
individual needs of consumers, and culturally relevant."
"Improving the Quality of Health Care for Mental and
Substance-Use Conditions" is posted at<www.nap.edu/catalog/11470.html?onpinewsdoc110120005>.▪