America will not have a high-quality health system if equal attention is not given to mental health issues and substance-use problems

Nov 7 2005

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.

http://www.nas.edu/