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Mental, neurological, and substance use disorders are common, highly disabling, and associated with significant premature mortality. The impact of these disorders on the social and economic well-being of individuals, families, and societies is large, growing, and underestimated. Despite this burden, these disorders have been systematically neglected, particularly in low- and middle-income countries, with pitifully small contributions to scaling up cost-effective prevention and treatment strategies. Systematically compiling the substantial existing knowledge to address this inequity is the central goal of this volume. This evidence-base can help policy makers in resource-constrained settings as they prioritize programs and interventions to address these disorders.
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.
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.
The main objective of this work is to provide a book with high quality content that becomes a reference and support for graduate course (Mental Health, Public Health and Epidemiology) and for research in the domain of health economics applied to mental health. Also this book might be useful for policymakers on formulating mental health policies. Key messages of this book are based on: a) mental illness represent a huge cost for society and for health care; b) health economics applied to mental health could help in the optimization of resource allocation for mental health care and for better decision making in terms of balancing costs and benefits; c) interventions and treatment should be also chosen in general medical practice and in public decision-policy according to cost-effectiveness, burden of disease and equity principles; d) quality of care is related with better outcomes, higher quality of life for clients, and with lower costs for society and health system (best value for money); e) it is possible to decrease the burden of mental disorders with cost-effective treatments. The book is divided in four main topics: 1. Introduction to Health Economics applied to Mental Health – this section is an overview of basic principles, concepts and methods used in Economics and Health Economics to enable students to make critical appraisal of Health Economics texts and also to design research studies in this topic. 2. Health Economics applied to the evaluation of quality and costs of Mental Health Services – this section presents results of Brazilian studies on the costs of mental health care (hospital, outpatient care, residential care, informal care), methods on the measurement of costs and it discusses issues related with public policies decisions and quality of mental health car in the low and middle income countries context. There is also an overview of quality indicators of mental health care and instruments to evaluate mental health services and costs.3. Health Economics applied to evaluate treatment of mental disorders - This section presents a review of cost-effectiveness of pharmacological treatments and other interventions applied for treating the most burdensome mental disorders such as depressive and anxiety disorders, bipolar disorders, psychosis, alcohol and drug disorders, dementia, and hyper attention deficit disorders. 4. Health Economics, burden and indirect costs of mental disorders - This section highlights the social and economic burden caused by mental illness under societal perspective focusing on stigma, unemployment, indirect costs in the workplace (absenteeism and presenteeism), the relationship between poverty and mental disorders, global health and social determinants of mental health and on the costs of mental disorders (depression, anxiety, psychosis, alcohol and drug disorders). We present some instruments to measure indirect costs of mental disorders.
How can professionals maintain or improve the quality of care they provide when pressured by payers to reduce the cost of care? Clinicians today face the challenge of providing optimal care in an environment where costs drive clinical practice. But high quality, not cost, remains the goal of professionals. By arming themselves with measurable results, clinicians can improve the processes of delivering mental health care and translate those improvements into better outcomes for patients and their families. In this timely guide, the editors have gathered the work of 49 distinguished contributors and crafted a valuable resource for overcoming the extraordinary challenge of delivering high quality mental health care. This groundbreaking book is divided into three sections: The challenges today's clinicians face in providing optimal mental health care -- Beginning with a review of the report to then-President Clinton from the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, subsequent chapters discuss professional ethics and managed care, how Wall Street investors are changing the practice of medicine, problems faced by managed care, and changes needed in medical education to ensure that physicians are well prepared to practice medicine in the 21st century. Proven techniques for quality measurement -- Measuring quality of care presents significant conceptual and methodological problems. These chapters review quality measurement methods and describe support by the federal government to improve these methods. Also addressed are how consumers are joining the quality of care measurement movement and how one large urban county mental health program is advancing quality measurement. Fourteen case reports of quality improvement projects -- These chapters detail principles and techniques that can be replicated or tailored to fulfill the requirements of a variety of clinical settings, ranging from the national health service in Great Britain to a small geriatric unit in a large hospital. The work showcased here was done by clinicians or administrators who, concerned about the quality of care in their own settings, used data to test for themselves whether their interventions resulted in improved care. Even if managed care disappeared, we would still need to question, examine, and improve the quality of patient care -- with clinicians taking the lead, because only they can appreciate the subtle nuances that maintain or improve quality standards, and only they can make substantive changes in their clinical settings. As both a broad conceptual framework for considering the quality of mental health care and as a practical field guide to real-life techniques for measuring the quality of care, this volume will prove exceptionally valuable for mental health care professionals, administrators, and policymakers as well as for consumers and consumer advocates, researchers, students, and public health professionals.
A compelling argument for improving society's mental health through increased services and better policy Mental illness is a leading cause of suffering in the modern world. In sheer numbers, it afflicts at least 20 percent of people in developed countries. It reduces life expectancy as much as smoking does, accounts for nearly half of all disability claims, is behind half of all worker sick days, and affects educational achievement and income. There are effective tools for alleviating mental illness, but most sufferers remain untreated or undertreated. What should be done to change this? In Thrive, Richard Layard and David Clark argue for fresh policy approaches to how we think about and deal with mental illness, and they explore effective solutions to its miseries and injustices. Layard and Clark show that modern psychological therapies are highly effective and could potentially turn around the lives of millions of people at little or no cost. This is because treating psychological problems generates huge savings on physical health care, as well as massive economic savings through more people working. So psychological therapies would effectively pay for themselves, generating potential savings for nations the world over. Layard and Clark describe how various successful psychological treatments have been developed and explain what works best for whom. They also discuss how mental illness can be prevented through better schools and a better society, and the urgency of doing so. Illustrating why we cannot afford to ignore the issue of mental illness, Thrive opens the door to new options and possibilities for one of the most serious problems facing us today.
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
The understanding of how to reduce risk factors for mental disorders has expanded remarkably as a result of recent scientific advances. This study, mandated by Congress, reviews those advances in the context of current research and provides a targeted definition of prevention and a conceptual framework that emphasizes risk reduction. Highlighting opportunities for and barriers to interventions, the book draws on successful models for the prevention of cardiovascular disease, injuries, and smoking. In addition, it reviews the risk factors associated with Alzheimer's disease, schizophrenia, alcohol abuse and dependence, depressive disorders, and conduct disorders and evaluates current illustrative prevention programs. The models and examination provide a framework for the design, application, and evaluation of interventions intended to prevent mental disorders and the transfer of knowledge about prevention from research to clinical practice. The book presents a focused research agenda, with recommendations on how to develop effective intervention programs, create a cadre of prevention researchers, and improve coordination among federal agencies.
This innovative volume presents a cogent case for quality improvement (QI) in behavioral healthcare as ethical practice, solid science, and good business. Divided between foundational concepts, key QI tools and methods, and emerging applications, it offers guidelines for raising care standards while addressing ongoing issues of treatment validity, staffing and training, costs and funding, and integration with medical systems. Expert contributors review the implications and potential of QI in diverse areas such as treatment of entrenched mental disorders, in correctional facilities, and within the professional context of the American Psychological Association. The insights, examples, and strategies featured will increase in value as behavioral health becomes more prominent in integrated care and vital to large-scale health goals. Included in the coverage: Behavioral health conditions: direct treatment costs and indirect social costs. /liliQuality improvement and clinical psychological science. · Process mapping to improve quality in behavioral health service delivery. · Checklists for quality improvement and evaluation in behavioral health. · Creating a quality improvement system for an integrated care program: the why, what, and how to measure. · Feedback Informed Treatment (FIT): improving the outcome of psychotherapy one person at a time. Quality Improvement i n Behavioral Healthcare gives health psychologists, public health professionals, and health administrators a real-world framework for maintaining quality services in a rapidly evolving health landscape.