Mental Health Services In General Health Care

Bringing together treatment and referral advice from existing guidelines, this text aims to improve access to services and recognition of common mental health disorders in adults and provide advice on the principles that need to be adopted to develop appropriate referral and local care pathways.

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.

Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.

This book is a primer on Stepped Care 2.0. It is the first book in a series of three. This primer addresses the increased demand for mental health care by supporting stakeholders (help-seekers, providers, and policy-makers) to collaborate in enhancing care outcomes through work that is both more meaningful and sustainable. Our current mental health system is organized to offer highly intensive psychiatric and psychological care. While undoubtedly effective, demand far exceeds the supply for such specialized programming. Many people seeking to improve their mental health do not need psychiatric medication or sophisticated psychotherapy. A typical help seeker needs basic support. For knee pain, a nurse or physician might first recommend icing and resting the knee, working to achieve a healthy weight, and introducing low impact exercise before considering specialist care. Unfortunately, there is no parallel continuum of care for mental health and wellness. As a result, a person seeking the most basic support must line up and wait for the specialist along with those who may have very severe and/or complex needs. Why are there no lower intensity options? One reason is fear and stigma. A thorough assessment by a specialist is considered best practice. After all, what if we miss signs of suicide or potential harm to others? A reasonable question on the surface; however, the premise is flawed. First, the risk of suicide, or threat to others, for those already seeking care, is low. Second, our technical capacity to predict on these threats is virtually nil. Finally, assessment in our current culture of fear tends to focus more on the identification of deficits (as opposed to functional capacities), leading to over-prescription of expensive remedies and lost opportunities for autonomy and self-management. Despite little evidence linking assessment to treatment outcomes, and no evidence supporting our capacity to detect risk for harm, we persist with lengthy intake assessments and automatic specialist referrals that delay care. Before providers and policy makers can feel comfortable letting go of risk assessment, however, they need to understand the forces underlying the risk paradigm that dominates our society and restricts creative solutions for supporting those in need.

This revised, expanded edition uses a public health framework and the latest epidemiological, therapeutic, and service systems research to give readers a comprehensive understanding of the organization, financing, and delivery of mental health and substance abuse services in the United States. Written by national experts, it will provide policymakers, administrators, clinicians, and graduate students with the knowledge base needed to manage and transform mental health service systems, both nationally and locally.

The primary objective of this book is to provide comprehensive descriptions and make comparative evaluations of each of the mental health systems of four Western, industrialized countries. The countries selected illustrate a continuum from a highly centralized and publicly financed, national health service in Great Britain to a predominantly decentralized and more privately financed market of mental health services in the United States. In between these two contrasting types are examples of national health services and insurance programs in Norway and Canada. Contributing experts from each country begin their chapters with an overview of the geographic, demographic, political, economic, and cultural contexts in which their mental health systems are situated. Thereafter, they (a) present national data to estimate the need for mental health services, (b) describe national mental health policies and programs designed to meet their population's need, (c) indicate how mental health services are organized and delivered, and (d) discuss how their system is financed and provided resources. A common chapter outline facilitates comparisons among all four systems on relevant evaluation criteria: (a) access and equity, (b) quality and efficacy, (c) cost and efficiency, (d) financing and fairness, (e) protection and participation, and (f) population relevance. In the final section of each chapter, the authors provide recommendations for improved performance of their mental health system. In the initial chapter, the editor provides an overview, introduces the four countries selected, and defines the evaluation criteria applied by all contributing authors. The final two chapters address convergence and divergence among the four systems and provide recommendations for improvement and for future comparative studies. The intended audience includes mental health policymakers, program administrators and managers; teachers of graduate level courses relat