Executive Summary

I. Quality Improvement

Section I of the 2004 edition of Mental Health, United States introduces the quality improvement model and its application to the mental health field. Manderscheid (chapter 1) provides a brief overview of this topic, followed by Daniels et al. (chapter 2), who describe the Crossing the Quality Chasm Model—a framework developed by the Institute of Medicine—as a tool to reform health care and improve its quality. Power (chapter 3) introduces the goals of the President’s New Freedom Commission on Mental Health—the guiding goals for transformation of mental health care in the United States—and links those goals to performance measures, which are critical to quality improvement efforts. The final two chapters in this section address more specialized topics. Bassman (chapter 4) recounts the history of the mental health consumer movement in the United States and the role it has played in quality improvement. Manderscheid (chapter 5) examines the role of information technology as a force that promotes transformation and that can be applied effectively to -improve the quality of care.

II. Measures To Improve Quality

Measures of quality are essential for any quality improvement initiative. Section II reviews such measures. Following a brief overview by Manderscheid of performance measures (chapter 6), Minden et al. (chapter 7) outline a range of quality tools available on the Decision Support 2000+ (DS2K+) Web site, including consumer and provider surveys, and vehicles for entering, processing, and bench-marking quality measures. DS2K+ is a key national infrastructure resource designed to foster better quality measurement. Bartlett et al. (chapter 8) -discuss developments in the Forum on Performance Measures in Behavioral Healthcare, a joint effort of the three centers of Substance Abuse and -Mental Health Services Administration (SAMHSA) to develop common measures across the mental health and substance abuse fields. Administrative measures currently are being tested, and a modular consumer survey is being completed. Smith and Gianju (chapter 9) introduce the MHSIP Quality Report, a second-generation Report Card designed to replace the original MHSIP Consumer-Oriented Report Card. Lutterman and Gonzalez (chapter 10) report progress in implementing the Uniform Reporting System (URS) in the States and Territories, including the subset of measures designated by the SAMHSA -Administrator as National Outcome Measures (NOMs). Finally, Lutterman et al. (chapter 11) report findings from the annual State Mental Health Agency Profile System, organized to show how the States and Territories are progressing in implementing the six goals identified in the report of the President’s New Freedom Commission on Mental Health.

III. Mental Health Care In Primary Care Settings

Section III highlights the fast-growing role of mental health care provided in primary care settings. Reiss-Brennan (chapter 12) introduces the topic by highlighting the importance of clinical and financial factors in this service arrangement. Druss et al. (chapter 13) summarize research and other evidence about the accessibility, quality of service delivery, and effectiveness of mental health care in this setting. Wang et al. (chapter 14) provide the most recent information about the prevalence of this type of care from community surveys.

IV. Population Assessments

Section IV examines population assessments to identify persons with mental illness from community surveys and cost assessments drawn from encounter payment data for consumers served in major public and private funding programs. Kessler et al. (chapter 15) provide detailed estimates for the adult population with serious mental illness from the National Comorbidity Survey Replication. Cowell et al. (chapter 16) report annual national and per-person expenditures for mental health and substance abuse services under Medicare, parallel annual State expenditures for four States under Medicaid, and annual program and per-person expenditures for several different private-sector insurance plans. Jonas et al. -(chapter 17) describe national estimates of depression in young adults that were derived from the -National Health Interview Survey, and Pastor et al. (chapter 18) offer the first national findings for a National Child Mental Health Indicator that were collected through this same survey.

V. National Service Statistics

Section V presents annual national service statistics collected through the Center for Mental Health Services National Mental Health Statistical Reporting Program. Foley et al. (chapter 19) report the most recent annual national and State statistical information on mental health organizations in the United States, and Crider et al. (chapter 20) report the most recent national statistical information on persons served in those organizations. Goldstrom et al. (chapter 21) summarize findings from the first-ever national survey of consumer-operated services. Finally, Duffy et al. (chapter 22) enumerate the latest statistical information on human resources, including trainees, in each of the core mental health disciplines.