Institute of Medicine (US) Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive DisordersWashington (DC): National Academies Press (US); 2006The National Academies Collection: Reports funded by National Institutes of Health
Millions of Americans today receive health care for mental or substance-use problems and illnesses. These conditions are the leading cause of combined disability and death among women and the second highest among men. Effective treatments exist and continually improve. However, as with general health care, deficiencies in care delivery prevent many from receiving appropriate treatments. That situation has serious consequences—for people who have the conditions; for their loved ones; for the workplace; for the education, welfare, and justice systems; and for the nation as a whole. A previous Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001), put forth a strategy for improving health care overall—a strategy that has attained considerable traction in the United States and other countries. However, health care for mental and substance-use conditions has a number of distinctive characteristics, such as the greater use of coercion into treatment, separate care delivery systems, a less developed quality measurement infrastructure, and a differently structured marketplace. These and other differences raised questions about whether the Quality Chasm approach is applicable to health care for mental and substance-use conditions and, if so, how it should be applied. This new report examines those differences, finds that the Quality Chasm framework can be applied to health care for mental and substance-use conditions, and describes a multifaceted and comprehensive strategy for doing so and thereby ensuring that: Individual patient preferences, needs, and values prevail in the face of residual stigma, discrimination, and coercion into treatment; The necessary infrastructure exists to produce scientific evidence more quickly and promote its application in patient care; Multiple providers' care of the same patient is coordinated; Emerging information technology related to health care benefits people with mental or substance-use problems and illnesses; The health care workforce has the education, training, and capacity to deliver high-quality care for mental and substance-use conditions; Government programs, employers, and other group purchasers of health care for mental and substance-use conditions use their dollars in ways that support the delivery of high-quality care; Research funds are used to support studies that have direct clinical and policy relevance and that are focused on discovering and testing therapeutic advances. The strategy addresses issues pertaining to health care for both mental and substance-use conditions and the essential role of health care for both conditions in improving overall health and health care. In so doing, it details the actions required to achieve those ends—actions required of clinicians; health care organizations; health plans; purchasers; state, local, and federal governments; and all parties involved in health care for mental and substance-use conditions.