Report
on mental illnesses and drug addictions says comprehensive
approach needed
WASHINGTON- Without a comprehensive strategy to improve the
quality of health care for people with mental conditions and
alcohol or drug problems, high-quality care in the nation's
overall health system and better health for the public are
goals that will remain unmet, says a new report from the
Institute of Medicine of the National Academies. The report
offers such a strategy, outlining key roles for government
officials, clinicians, health care organizations, health
plans, and purchasers -- companies or other groups that
compensate health care providers for delivering services to
patients.
The diagnoses and severity of mental and substance problems
vary widely -- from distress caused by a life-changing event
to severe depression to physical dependence on alcohol. Each
year more than 33 million Americans, many of whom are
working adults, use health care services for such
conditions. And research shows that successful,
cost-effective treatments exist. However, as with general
health care, the delivery of high-quality interventions can
be spotty, and poor care has serious consequences: Mental
health problems and alcohol and drug issues are leading risk
factors for suicide. Furthermore, the consequences ripple
throughout the U.S. education, legal, and welfare systems
and the workplace in the forms of lost productivity, low
academic achievement, and dysfunctional behavior.
"America will not have a high-quality health system if equal
attention is not given to mental health issues and
substance-use problems," said Mary Jane England, president,
Regis College, Weston, Mass., and chair of the committee
that wrote the report. "Mental health is inextricably linked
with health and well-being, but treatment for mental
conditions and inappropriate use of substances is often
separated from other health care."
Health services for these conditions have been isolated not
only from other components of the health system but also
from each other, despite the fact that many people have both
mental conditions and problems with alcohol or drugs. 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, the report
says.
Government agencies, purchasers, health plans, and
accrediting groups also should create incentives and
policies to increase collaboration among all health care
providers, the report says. The U.S. Department of Health
and Human Services should lead these efforts by establishing
a permanent, high-level mechanism to foster greater
coordination across the department's mental, substance-use,
and general health care agencies.
A
broad range of providers is licensed to diagnose and treat
mental health and substance-use illnesses. Consequently,
their training levels and therapeutic approaches often
differ, leaving the overall work force with an uneven
distribution of the knowledge and skills necessary to
provide consistent, high-quality services. Congress should
authorize and fund a Council on the Mental and Substance-Use
Health Care Work Force to develop and implement plans to
help professionals improve the quality of their care, the
report says. Licensing boards, accrediting organizations,
and purchasers should adopt any national standards
identified by the council, which would operate as a
partnership between the public and private sectors.
Likewise, government programs, employers, and purchasers
should allocate funds in ways that better support the
delivery of high-quality care, the committee said. For
example, states should revamp how they purchase health care
services, giving more weight to the quality of care that
vendors would provide.
Health professionals' ability to quickly obtain and share
information on a patient's health and potential treatments
is essential to effective care, the report says. Federal and
state governments should revise laws, regulations, and
administrative practices that hinder such information
sharing.
Public-private partnerships are now developing an
information technology system called the National Health
Information Infrastructure (NHII) to make the exchange of
health information easier. But so far, these efforts have
not adequately dealt with health care for mental and
substance-use problems, the report says. HHS and the U.S.
Department of Veterans Affairs should take steps to ensure
that NHII will thoroughly address such conditions.
Additionally, federal and state governments, purchasers, and
foundations should offer clinicians and groups who treat
these problems incentives to invest in the information
technology needed to fully participate in NHII.
HHS should synthesize and disseminate scientific evidence on
effective services for mental and substance-use conditions,
the report adds. It also should lead efforts to
significantly develop an infrastructure for measuring and
improving the quality of mental and substance-use health
care. To this end, the department, working with the private
sector, should charge and fund a group similar to the
National Quality Forum -- a private, nonprofit organization
-- to identify and put into practice quality measures in
these areas. And HHS should oversee a coordinated research
agenda for improving care.
The report -- like the Institute of Medicine's 2001 report
CROSSING THE QUALITY CHASM: A NEW HEALTH SYSTEM FOR THE 21ST
CENTURY -- envisions a revamped health care system that not
only is centered on the needs, preferences, and values of
patients, but also encourages teamwork among health care
workers and makes much greater use of information
technology. Patient-centered care is especially important in
the delivery of mental health services and treatments for
addictions, the report says, because of the stigma sometimes
associated with interventions and greater use of coercion
into treatment compared with general health care.
The study was sponsored by the Annie E. Casey Foundation;
CIGNA Foundation; U.S. Department of Veterans Affairs;
Robert Wood Johnson Foundation; and the U.S. Department of
Health and Human Services' Substance Abuse and Mental Health
Services Administration, National Institute on Alcohol Abuse
and Alcoholism, and National Institute on Drug Abuse. The
Institute of Medicine is a private, nonprofit institution
that provides health policy advice under a congressional
charter granted to the National Academy of Sciences
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