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Winter/Spring 2006 Vol. 6 No. 1

Table of Contents

A Health Care Disconnect

©Paul Schulenburg/

Caring for Both Mind and Body

Each year more than 33 million Americans, many of them working adults, use health care services for mental and substance problems. When appropriately treated, people can lead satisfying, productive lives. But without proper treatment, the consequences can be devastating -- lost jobs, low academic achievement, antisocial behavior, even suicide.

Successful, cost-effective treatments and interventions for mental problems and substance use do exist, but unfortunately delivery of these measures is spotty at best. Without a comprehensive strategy to improve the quality of care in these areas, high-quality care in the nation's overall health system is a goal that will remain unmet, says a new Institute of Medicine report that offers such a plan.

Building bridges is key. Modern scientific thought does not separate mind and body, but services for mental and substance-use problems have been isolated from the rest of the health system and often from each other, despite the fact that many people suffer from both types of conditions. Health professionals need to connect relevant areas of their own organizations as well as form ties with other providers, the report says. And federal and state governments should revise laws and practices that hinder the ability of health professionals to quickly obtain and share information on a patient's health and potential treatments -- links that are essential to effective assistance. Likewise, the U.S. Department of Health and Human Services should establish a permanent, high-level mechanism to encourage greater coordination across its mental, substance-use, and general health care agencies.

An information technology system called the National Health Information Infrastructure (NHII) is now being developed to make the exchange of health information easier. But so far, these efforts have not fully dealt with health care for mental and substance-use problems, the report says. HHS and the U.S. Department of Veterans Affairs should make sure that this system adequately addresses such conditions.

Policymakers also should pay closer attention to the work force itself. Critical skills and knowledge are unevenly distributed among a broad range of providers, the report notes. Congress should authorize and fund a Council on the Mental and Substance-Use Health Care Work Force, which would aim to strengthen professional standards as well as training. The council should operate as a partnership between the public and private sectors.

The principle of putting your money where your mouth is would make a difference, too, said the committee that wrote the report. Government programs, employers, and purchasers -- companies or other groups that pay health care providers for delivering patient services -- should spend money in ways that support the delivery of high-quality care. When sizing up prospective vendors, for example, states should give more weight to those who stress this kind of excellence.

HHS, the report adds, should oversee a coordinated research agenda for improving health care services for mental and substance problems. The agency's efforts should include synthesizing and disseminating scientific evidence.

The report -- like the IOM's 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century -- envisions a revamped health care system that is centered on the needs and preferences of patients, encourages teamwork among health care workers, and makes much greater use of information technology. Patient-centered care is imperative in the delivery of mental health services and treatments for addiction, the report says, because there is greater use of coercion into treatment compared with general health care. And interventions sometimes carry social stigmas.
  -- Vanee Vines

Improving the Quality of Health Care for Mental and Substance-Use Conditions . Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, Board on Health Care Services, Institute of Medicine (2005, approx. 600 pp.; ISBN 0-309-10044-5, available from the National Academies Press, tel. 1-800-624-6242; $60.00 plus $4.50 shipping for single copies).

The committee was chaired by Mary Jane England, president, Regis College, Weston, Mass. The study was sponsored by the Annie E. Casey Foundation; CIGNA Foundation; U.S. Department of Veterans Affairs; Robert Wood Johnson Foundation; and the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration, National Institute on Alcohol Abuse and Alcoholism, and National Institute on Drug Abuse.

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Copyright 2006 by the National Academy of Sciences