Improving the Quality of Health Care for Mental and Substance-Use Conditions (2006) / Chapter Skim
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1 The Quality Chasm in Health Care for Mental and Substance-Use Conditions
1 The Quality Chasm in Health Care for Mental and Substance-Use Conditions
Pages 29-55
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From page 29... ...
When appropriately treated, individuals with these conditions can recover and lead satisfying and productive lives. Conversely, when treatment is not provided or is of poor quality, these conditions can have serious consequences for individuals, their loved ones, their workplaces, and the nation as a whole.
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From page 30... ...
MORE THAN 33 MILLION AMERICANS ANNUALLY RECEIVE CARE Each year more than 33 million Americans use mental health services or services to treat their problems and illnesses2 resulting from alcohol, inappropriate use of prescription medications, or illegal drugs. Approximately 28 million Americans aged 18 or older (13 percent of this population)
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From page 31... ...
. Fewer than half of adults aged 1854 who met a definition of severe mental illness received treatment for the condition during a 12-month period between 2001 and 2003 (Kessler et al., 2005)
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. a person with mental illness can recover even though the illness is not "cured".
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From page 33... ...
, to providing supported housing for homeless persons with mental illness (Rosenheck et al., 2003)
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. This has been especially true of those with the most severe mental illnesses (Kessler et al., 2005; Mechanic and Bilder, 2004)
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. In other clinical care situations, the absence of clinical practice guidelines further contributes to worrisome variation in the care individuals receive.
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. A later longitudinal study of 1,088 youths in residential or outpatient treatment for drug use showed that although 67 percent reported having severe mental health problems upon admission, only 24 percent reported receiving mental health services within the 3 months following their admission (Jaycox et al., 2003)
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From page 37... ...
In 1996, unipolar major depression was second only to ischemic heart disease for American women as the cause of DALYs. For men, traffic accidents ranked second; alcohol abuse and dependence ranked fifth; and depression and drug use ranked tenth and eleventh, respectively.
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From page 38... ...
11Includes only spending for health care in which M/SU illnesses are listed as the primary illness being treated. Thus, for example, costs of treating cirrhosis secondary to alcohol dependence are not captured; nor, for example, are other health problems brought on by substance use if the substance-use illness is not being treated, and other indirect costs of these illnesses, such as costs to the juvenile and criminal justice systems.
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From page 39... ...
, major depression continues to be associated with poor work performance more consistently than is the case for other high-prevalence conditions (allergies, arthritis, back pain, headaches, high blood pressure, and asthma)
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. Although risk factors often associated with substance-use problems and illnesses (such as poor maternal nutrition, health, and prenatal care)
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. Finally, the stresses involved with child protective services investigation and judicial decision making, and for those who are placed in foster care the stress of removal from home, also constitute risk factors for maladaptive outcomes, including emotional, social, behavioral, and psychiatric problems warranting mental health treatment (Landsverk, 2005)
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secure juvenile detention facilities in the United States,12 two-thirds of such facilities reported holding youths (prior to, after, or absent any pending adjudication) because they were awaiting community mental health services.
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, approximately 95 percent of state correctional facilities report providing some form of mental health treatment to prisoners. The treatment provided includes screening for mental illness at intake (78 percent)
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. Treatment for this and other M/SU illnesses also might help ameliorate the adverse effects of emotional or behavioral problems and illnesses on children's educational achievement, as well as reduce the burden on the child welfare and juvenile justice systems.
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From page 45... ...
the environment of policy, payment, regulation, accreditation, and similar external factors that shape the context in which health care organizations deliver care. Whereas To Err Is Human speaks mainly to the fourth level, Crossing the Quality Chasm addresses primarily the first and second levels -- how the experiences of patients and the work of microsystems of care, such as health care teams, nursing units, or individual health care workers delivering care to patients, should be changed (Berwick, 2002)
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From page 46... ...
Casey Foundation, the CIGNA Foundation, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, The Robert Wood Johnson Foundation, SAMHSA within the U.S. Department of Health and Human Services, and the Veterans Health Administration of the U.S.
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From page 47... ...
Finally, Crossing the Quality Chasm sets forth a "patient-centered, treatmentfocused" approach to improving individual health care, as opposed to a "population-centered, prevention-focused" approach to improving public health. The committee recognizes that much work is needed to apply public health interventions to M/SU problems and illnesses and briefly touches on a few of these issues in this report.
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From page 48... ...
2002. A review of quantitative studies of adherence to mental health clinical practice guidelines.
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2003. Child Welfare and Juvenile Justice: Federal Agencies Could Play a Stronger Role in Helping States Reduce the Number of Children Placed Solely to Obtain Mental Health Services.
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2004a. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alco hol and Related Conditions.
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2004, November 29. Mental illness sends many to foster care.
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U.S. spending for mental health and substance abuse treatment, 19912001.
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1992. Prevalence of mental disorders among youth in the juvenile justice system.
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Drug and Alcohol Dependence 36(2)
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2003. Use of substance abuse treatment services by persons with mental health and substance use problems.
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