Box 5
Example of Quality Care for Serious Mental Illness

  • Program: TMAP - Texas Medication Algorithm Project
  • Goal: To ensure quality care for serious mental illness through the development, application, and evaluation of medication algorithms. An algorithm is a step-by-step procedure, in the form of a flow chart, to help clinicians deliver quality care via the best choice of medications and brief assessment of whether they work. The target population is serious and chronically ill people served by public programs.
  • Features: Development of algorithms by research physicians, as well as development of consumer education materials and other tools for treating serious mental illness. Public sector-university collaboration with support of stakeholders, education and technical assistance, and administrative supports to serve the most medically complex patients. Early phases of the project developed and tested the benefits; the program's latest phases are to be implemented everywhere in the state of Texas.
  • Outcomes: The algorithm package, implemented by Texas, was more effective than treatment-as-usual for depression, bipolar disorder, and schizophrenia (Rush, 2000; Rush, 2001). It reduced symptoms, side effects, and improved functioning. The package's benefit for reducing incarceration is being studied.
  • Biggest Challenge: To ensure that the entire algorithm package— patient education, frequent medical visits, medication availability, and consultation—is properly implemented in other states and localities.
  • How Other Organizations Can Adopt: Conduct an active planning process, including meetings with stakeholders, to examine what organizational changes are needed to make the algorithm work best.
  • Contact Point: Dr. John Rush, Prof. of Psychiatry, Univ. of Texas Southwestern Medical Center, Dr. Steve Shon, Medical Director of the Texas Department of Mental Health and Mental Retardation; Dr. M. Lynn Crismon, University of Texas at Austin
  • Sites: States of Texas, Nevada, Ohio, Pennsylvania, South Carolina, New Mexico; Atlanta and Athens, Ga.; Louisville, Kentucky; Washington D.C.; San Diego County; and private sector in Denver, Colorado

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