Improving the Quality of Mental Health Care
There have been many Congressional efforts to improve mental health care. However, recent initiatives with a broader scope of improving the overall quality of care in the United States have underemphasized mental health. Researchers from RAND and UCLA have identified three steps to accelerate progress in improving the quality of mental health care.
- Expand the pool of effective quality-improvement programs and adapt them to a broader range of settings. The quality of mental health care would benefit from increasing the range of disorders, ages, and groups for which effective programs exist and by adapting programs to diverse groups and service settings. Another clear need is for quality improvement in multiple settings for the treatment of common disorders, such as attention deficit hyperactivity disorder (ADHD).
- Improve the infrastructure for delivering quality treatment. To translate improvement initiatives into gains, the mental health care system needs better infrastructure. Gaps in the current system, such as a lack of accountability mechanisms, standards, and competency requirements, can hinder quality improvement. Filling these gaps will require strong leadership from within the mental health care profession, supported by market incentives to encourage providers to adopt standards or seek added training.
- Promote innovation in financing. Financial incentives can spur adoption of quality-improvement programs, but effective financing tools for this purpose have not yet been fully developed in the mental health care field. Innovations in financing must account for the system’s complexity—its division into public and private spheres—while supporting a responsible infrastructure in which service access, efficiency, and quality are core values. One innovative approach is pay-for-performance (P4P), which links financial incentives for providers to quality indicators, such as patient satisfaction.
The analysis concludes that engaging the public across a diverse group of stakeholders—including providers, payers, policymakers, consumers, researchers, and professional organizations—is central to quality improvement in mental health care.
Improving General Health Care for People with Severe Mental Illness
Adults with severe mental disorders also suffer from higher-than-average rates of chronic physical illness, such as hypertension and diabetes. Yet this population has less access to treatment and receives a poorer quality of care than adults without mental illness. A key contributor to this problem is the disconnection between the mental health care sector, which provides most care to the severely mentally ill, and the general health care sector. To address this problem, a team of researchers from the University of Pittsburgh and RAND recommended improving clinical integration between these sectors and outlined several steps toward achieving this goal: (1) reorganize mental health service delivery to facilitate clinical integration so that mental health providers play a greater role in meeting the general health care needs of the severely mentally ill; (2) promote greater communication and collaboration among providers across the mental health and general health sectors through the adoption of integrated clinical information systems; (3) better prepare the health care workforce to meet all the health care needs of this population; (4) develop financing policies and practices that reward integrated care, such as building into reimbursement policies provisions for cross-care and expectations for coordination and information-sharing; (5) strengthen accreditation processes so that accredited health plans share uniform coordination-related requirements; and (6) develop federally sponsored research to evaluate quality-improvement interventions and evidence-based practices for people with severe mental illness that might be well-suited to improving this population’s general health outcomes.
Integrating Treatment for People with Co-Occurring Mental Health and Substance Abuse Disorders in Public Systems of Care
People with co-occurring mental health and substance abuse disorders often must navigate a fragmented care system. Historically, treatment for these conditions has been delivered and financed separately. In recent years, Congress has debated this issue during hearings for the Substance Abuse and Mental Health Services Administration (SAMHSA) reauthorization. However, there have been successful efforts to deliver more integrated care that treats both conditions. A RAND study examined these efforts. The analysis suggested that progress is being made in two key areas:
- Integrated treatment models. New treatment models have emerged that combine mental health and substance abuse care at the client level. The most common approach is integrated dual disorders treatment (IDDT), which provides intensive and comprehensive services for severe mental health and substance abuse disorders simultaneously.
- Innovative financing arrangements. To overcome obstacles posed by separate funding streams, some states have developed financing strategies that integrate support services for co-occurring disorders through the provider agency. A few states have undertaken broader Medicaid reforms that operate through contracts with managed-care organizations to create more flexibility to fund both mental health and substance abuse treatment.
The study pointed to three promising directions for further improvement: (1) widespread adoption of clinical models that emphasize service delivery in a single setting; (2) greater commitment by state authorities to support integrated care for each population and setting; and (3) federal policy changes that create opportunities for states to develop and sustain integrated models of care for co-occurring disorders within the fiscal and regulatory environment of the substance abuse treatment system.
RAND CONGRESSIONAL RESOURCES STAFF
Executive Vice President
Director, Office of Congressional Relations
Health Legislative Analyst
RAND Office of Congressional Relations
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