"What is commonly referred to in the U.S. as the "mental health care system" is not really a system at all. While excellent programs exist in every state, in every community across America the "system" is actually a set of fragmented services provided inequitably by a haphazard array of specialty providers, often with inadequate resources and only tenuously connected to health care systems for other health needs. Crisis is too often the first point of contact for people experiencing a mental illness, while year-over-year increases in rates of anxiety, depression, traumatic stress, and death from suicide and overdose have led many to characterize the current situation as a 'pandemic' or 'epidemic' of mental illness, constituting a 'national emergency.' For youth and young adults, in late 2021 this emergency was formally recognized by the U.S. Surgeon General in the first Advisory ever issued regarding the nation's mental health"--

One in five U.S. adults experiences a mental illness within a given year. With more than 550,000 people working to support this underserved community, the mental healthcare system has grappled with inadequacies and shortcomings in safety, quality, and care delivery. There is a wide range of problems, from access-to-care issues and errors, to complications stemming from poor care. Our country is also on an unsustainable path as our healthcare expenditure keeps growing. To add to all of this, we are facing a rampant epidemic of burnout among healthcare workers. Modern advancements introduced with many promises—such as electronic medical records, newer medications, or advanced treatments—have created unique challenges when ushered into a highly regulated healthcare system. What does it take to provide patients with everything they need—the right quality of care, at the right time, and at the right cost—to keep them healthy? Which process steps add value? Which steps are wasteful? A widely accepted fact is that a conservative 30-50% of every step in the mental healthcare process does not help patients feel better or stay better. When considering delays in care, workarounds, excessive documentation, and an overuse of auditing, the care system has moved highly skilled clinicians away from providing value, as administrative tasks continue to encroach on their time. There is a clear need to rethink and redesign the system of care. This book is a primer for understanding the current state of the mental health system and the performance improvement skills and leadership acumen needed to address existing challenges. Sheppard Pratt, the award-winning, leading institution for mental healthcare in America, provided the focus on mental healthcare and became the laboratory for this body of work over the course of eight years. It hired a seasoned systems thinker with improvement expertise to work with mental health professionals and solve some of their most complex and chronic problems. The book is a result of the collaboration between a practicing psychiatrist in a leadership role and the systems engineer. Working together, they demonstrate how to think about redesigning care and redefining the nature of work to enhance value for both the people served and the healthcare workforce. They crafted a multi-pronged approach towards culture change at Sheppard Pratt, including implementing a course on "Learning to Improve," which introduced staff to a performance improvement methodology. There are several vignettes interwoven throughout the book that describe the complexities and constraints of the system. Solving some of these challenges creates a new paradigm of work while minimizing waste and enhancing value.

Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.

While citizens usually want more from government, they generally are included to pay less in taxes. When resources become scarce, as has been the case for most public jurisdictions, innovative methods must be developed for responding to service and cost pressures. How can this be done? A Workbook in Redesigning Public Services stresses a hands-on, how-to approach to diagnosing service delivery problems, analyzing alternative ways of delivering services, and communicating solutions to the policy makers. Among the service options considered are contracting with a private firm, inter-governmental agreements, self-help, franchises, grants and subsidies, and vouchers.

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Mental disorders are among the most prevalent sources of disease burden in the world. Increasing recognition of this burden has led to an explosion of scientific research as well as widespread public attention. Understanding causes and consequences of mental health and mental disorders from the perspective of public health involves unique methods and concepts from many disciplines, including population-based surveys in a life course framework. Prevention and control of mental disorders involves design and execution of intervention trials to prevent disorder in individuals who are currently healthy, and to minimize future consequences for those with current disorder or a history of disorder. Interventions of this type are important because good mental health protects against onset of a variety of mental disorders, as well as being a valued outcome in itself. The complexity of the brain and its relationship to social life requires concepts, methods, and syntheses that are new for epidemiology and public health. Public Mental Health provides a comprehensive introduction and reference for the public health approach to mental and behavioral disorders, and to promotion of mental health. The volume's chapter authors and coauthors are drawn from the internationally renowned faculty of the Department of Mental Health of the Johns Hopkins Bloomberg School of Public Health, a department uniquely positioned to create this important resource for researchers, students, and public health practitioners. The volume explicates the latest methodologies for studying the occurrence of mental disorders in populations and provides estimates of burden, cultural differences, natural history, and disparities between population subgroups. It includes reviews of genes as sources of risk for mental disorders, the occurrence of stresses and their timing over the life span, and crises and disasters as sources of risk. The book includes chapters on the structure and functioning of the mental health service system in the United States, and around the world, and a comprehensive review of population-based strategies of intervention to lower risk. A final chapter lays out a path for the evolution of public mental health in the future.

The rapid spread of managed care into public and community mental health systems is creating a dramatic transformation of traditional public sector settings. This radical change is affecting administrators, managers, and clinicians.Intended as a survival manual, this book begins with an overview of the history, concepts, ideology, and ethics of public sector managed care and then proceeds in focus from system to program management to clinical program levels. With a concluding section on advocacy, evaluation, research, and training issues, Managed Mental Health Care in the Public Sector examines how public sector managed mental health care can be approached with a positive spirit, an excitement about the potential to create dramatic and beneficial system changes, and a genuine interest in investigating the relative merits of every aspect of managed care systems.