IMPROVING THE QUALITY OF HEALTH CARE FOR MENTAL AND SUBSTANCE-USE CONDITIONS

Abstract: 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 of women and the second highest of 
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 our 
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 is applicable to 
health care for mental and substance-use conditions, and describes a 
multifaceted and comprehensive strategy to do so and thereby ensure 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 studies to discover and test new therapeutic advances.

The strategy addresses issues pertaining to health care for both mental and 
substance-use conditions and the essential role that health care for both 
plays in improving overall health and health care. In doing so 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.  

People Who experience mood swings, fear,
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