Applying the Institute of Medicine Quality Chasm Framework to Improving Health Care for Mental and Substance Use Conditions

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This article describes the two major phenomena that shaped the overall findings of the Institute of Medicine report Improving the Quality of Health Care for Mental and Substance Use Conditions and that informed its overarching recommendations. These phenomena are (1) the co-occurrence of mental health, substance use, and general health conditions; and (2) differences in the delivery of services for mental health/substance use and general health care. It describes efforts currently underway that address these differences and might significantly improve delivery and outcomes of mental health/substance use services.

Section snippets

Co-occurrence of Mental Health, Substance Use, and General Health Conditions

One of the Committee's overall findings is that mental, substance use, and general illnesses are highly interrelated, especially with respect to chronic illness and injury [16], [17]. The rates of co-occurrence of mental health and substance use conditions are high, estimated at 15% to 40% [18], [19], [20]. They also accompany a substantial number of chronic illnesses, such as cancer, diabetes, and heart disease [16]. Forty percent to 56% of individuals who have mental illness have a clinically

Differences in the Delivery of Services for Mental Health/Substance Use Compared with General Health Care

The Committee also found that health care for mental health/substance use, like general health care, often is ineffective, not patient-centered, untimely, inefficient, inequitable, and at times unsafe, and that it, too, requires fundamental redesign. A review of all peer-reviewed studies published between 1992 and 2000 assessing the quality of care for many different clinical conditions found that only 27% of the studies reported adequate rates of adherence to established, evidence-based

National and Local Efforts for Improving the Quality of Mental/Substance Use Health Care

In the face of these complexities, it is clear that innovative approaches to quality improvement in the arena of mental health/substance use need to be developed and implemented by multiple stakeholders at all levels of the health care system. Among the numerous recommendations put forth by the Committee are strategies for bridging knowledge gaps about treatment, the effectiveness of care delivery, and mechanisms and processes for improving quality in routine clinical practice as well as across

Summary

The work of the Committee on Crossing the Quality Chasm: Adaptation to the Mental Health and Addictive Disorders and the resulting IOM report Improving the Quality of Health Care for Mental and Substance Use Conditions represent another important milestone along the road to improving the quality of United States health care. Although it remains unclear to what extent this second call for action by the IOM will result in significant improvements in the quality of the mental/substance use health

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    This article was supported by multiple contracts and grants from the Robert Wood Johnson Foundation (grant #48021), the US Department of Veterans Affairs (contract #101-G67214/101-G67215), UPMC For You, Highmark Foundation, Staunton Farm Foundation, FISA Foundation, with matching support from the Centers for Medicare and Medicaid.

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