The Behavioral Health Care System Is Poised for Change

When the Institute of Medicine (IOM) quality improvement framework was first introduced to repair the nation's ailing health care system, behavioral health stakeholders were concerned that it might not work for mental health and substance use disorders. But an examination shows that the IOM framework is being incorporated into numerous nationwide projects targeting care for these conditions, suggesting that the behavioral health care system is "poised for change," according to researchers from RAND and the University of Pittsburgh.

More than 33 million Americans are treated annually for mental health and substance use disorders. Arriving at quality improvement for their care was a stepwise effort marked by the following IOM reports:

• 2000: To Err Is Human: Building a Safer Health System, the seminal report spotlighting a health care system that, at best, offers Americans a 50 percent chance of receiving the care they need when they need it.
• 2001: Crossing the Quality Chasm: A New Health System for the 21st Century, a comprehensive framework for fixing the nation's health care system.
• 2005: Improving the Quality of Health Care for Mental and Substance Use Conditions, a report showing that the IOM "quality chasm" framework also applies to the distinct health care challenges posed by behavioral health disorders.

In their commentary, the researchers noted that a number of behavioral health quality improvement projects currently under way are implementing IOM recommendations. Researchers from the RAND-University of Pittsburgh Health Institute, a collaboration between RAND Health and the University of Pittsburgh Schools of the Health Sciences, are participating in three of these efforts:

• Depression in Primary Care: Linking Clinical and System Strategies. Funded by the Robert Wood Johnson Foundation, this $12 million national program seeks to increase the use of effective models for treating depression in primary care settings. This program funds demonstration projects, innovative research projects, and grants for leadership development within primary care medical specialties.
• VA Mental Health Services Evaluation. This $6.5 million evidence-based evaluation is assessing mental health care services provided to veterans with schizophrenia, bipolar disorder, major depressive disorder, posttraumatic stress disorder, or substance use disorder. Funding for this evaluation comes from the Office of Policy, Planning, and Preparedness of the Department of Veterans Affairs.
• Bridging the Silos of Medicaid Managed Care. This three-year community-based quality improvement initiative seeks to bridge the physical and mental health care systems to enhance service delivery for maternal depression among at-risk pregnant women or mothers in Allegheny County, Pennsylvania. The program is funded by a consortium of local foundations with matching support from the Centers for Medicare & Medicaid Services.