"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.

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.

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.

Studies confirm that the physical environment influences health outcomes, emotional state, preference, satisfaction and orientation, but very little research has focused on mental and behavioural health settings. This book summarizes design principles and design research for individuals who are intending to design new mental and behavioural health facilities and those wishing to evaluate the quality of their existing facilities. The authors discuss mental and behavioural health systems, design guidelines, design research and existing standards, and provide examples of best practice. As behavioural and mental health populations vary in their needs, the primary focus is limited to environments that support acute care, outpatient and emergency care, residential care, veterans, pediatric patients, and the treatment of chemical dependency.

An exceptional opportunity is being missed. A chance to alleviate suffering and to achieve health care cost reductions for society is available, but is being ignored. There is an explosion of new knowledge about the emotional and intellectual development of children, and the causes and treatment of psychiatric disorders of children and adolescents. Research from diverse disciplines such as the developmental neurosciences, psychoanalysis, psychopharmacology, developmental psychology, and genetics propels us forward,. However, the effects of this new knowledge reach children and adolscents slowly, or not at all. The long history of neglect of the mental health of children and adolescents is now exaggurated by sudden, disruptive economic and political influences on mental health services for children and adolescents in most countries. Prevention and treatment of emotional and intellectual problems in childhood and adolescence have vastly improved, but utilization of these advantages lags behind. This disappointing incongruity stimulates a need to document our knowledge about these services and systems and to make it more broadly available. This is the primary aim of this new volume by a team of distinguished contributors. It reviews the causes and prevalences of psychiatric disorders in children and adolescents, the problem of health care financing for these services, the underutilization of these services, our current understanding of the outcomes of treatment, and the new models for both treatment and prevention. The book also provides a survey of current mental health services and sytems for children and adolescents in countries across the world. Information drawn from these multiple perspectives is has been used by a group of international experts to develop the Venice Declaration, providing specific guidelines for families, clinicians, administrators, and policy-makers who are concerned with the development of children and adolescents, and are committed to a more efficient economic approach to mental health services.

The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.