Transforming the Mental Health System

1. Transforming the Mental Health System Linking General Health and Mental Health: Considerations from Two Reports Prepared by Ted J. Johnson, M.A.

2. SOURCE From Policy to Service: A Quality Vision for Behavioral Health Using the Quality Chasm and New Freedom Commission Reports as a Framework for Change - American College of Mental Health Administration Prepared by Ted J. Johnson, M.A.

3. Overview • Consensus • Current health systems do not work • Current health systems are in need of fundamental reform Prepared by Ted J. Johnson, M.A.

4. Quality Chasm Series Produced by Institute of Medicine 2000 – 2003 Prepared by Ted J. Johnson, M.A.

5. Quality Chasm Series(continued) • Role of federal government and the role of performance measurement in purchasing healthcare • Leadership by Example: Coordinating Government Roles in Improving Health Care Quality, 2002 • Promising Quality Improvement Conditions • Priority Areas for National Action: Transforming Health Care Quality, 2003 Prepared by Ted J. Johnson, M.A.

6. Quality Chasm Series(continued) • Review of medical errors • To Err is Human, 2000 • Examination of quality • Crossing the Quality Chasm: A New Health System for the 21st Century, 2001 • Examination of Health Disparities • Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2002 Prepared by Ted J. Johnson, M.A.

7. Obstacles to QualityMental Health Care • Stigma surrounding mental illnesses • Unequal limitation and financial requirements placed on mental health benefits in privately insured health care • Fragmented mental health delivery system – Charge to New Freedom Commission, 2003 President George W. Bush Prepared by Ted J. Johnson, M.A.

8. Institute of Medicine Assertions Incremental Change – trying harder with existing models – will not work Reform can only be achieved through fundamental change or transformation Prepared by Ted J. Johnson, M.A.

9. President’s New Freedom Commission • Six goals • Americans understand that mental health is essential to overall health • Mental health care is consumer and family driven • Disparities in mental health services are eliminated • Early mental health screening, assessment, and referral to services are common practice • Excellent mental health care is delivered and research is accelerated • Technology is used to access mental health care and information Prepared by Ted J. Johnson, M.A.

10. Institute of Medicine • Core values for healthcare: • Safe • Person-centered • Efficient • Effective • Timely • Equitable Prepared by Ted J. Johnson, M.A.

11. Institute of Medicine • Ten rules to guide and direct the delivery of care: • Care is based upon continuous healing relationships • Customization is based on patient needs and values • The patient is the source of control • Shared knowledge and the free flow of information is essential Prepared by Ted J. Johnson, M.A.

12. Institute of Medicine • Ten Rules (continued) • Decision-making is evidence based • Safety is a system priority • There is a need for transparency in all aspects of healthcare delivery • Needs are anticipated • The reduction of waste is ongoing • Cooperation among clinicians is a priority Prepared by Ted J. Johnson, M.A.

13. LEVEL Experience of Patients and Communities Micro-systems of Care Healthcare Organizations Public Environment IMPACT Recipients of care Direct care providers Larger health systems Policy, financing, and regulations Four Levels = Focus of ChangeBerwick, D.M. 2002. A User’s Guide for the IOM’s ‘Quality Chasm’ Report. Health Affairs(Millwood) 21 (3):80-90 Prepared by Ted J. Johnson, M.A.

14. Institute of MedicineQuality Chasm Report • Activities and opportunities for immediate focus: • Applying evidence to the delivery of healthcare services • Using information technology • Aligning payment policies with quality improvement • Preparing the workforce to follow the rules and achieve the aims Prepared by Ted J. Johnson, M.A.

15. New Freedom CommissionGoals and Objectives Prepared by Ted J. Johnson, M.A.

16. New Freedom CommissionGoals and Objectives Prepared by Ted J. Johnson, M.A.

17. New Freedom CommissionGoals and Objectives Prepared by Ted J. Johnson, M.A.

18. New Freedom CommissionGoals and Objectives Prepared by Ted J. Johnson, M.A.

19. Comparing IOM with President’s New Freedom Commission Prepared by Ted J. Johnson, M.A.

20. Comparing IOM with President’s New Freedom Commission Prepared by Ted J. Johnson, M.A.

21. Comparing IOM with President’s New Freedom Commission Prepared by Ted J. Johnson, M.A.

22. Comparing IOM with President’s New Freedom Commission Prepared by Ted J. Johnson, M.A.

23. Safe: Services are provided in an emotionally and physically safe, compassionate, trusting and caring treatment/working environment for all clients, family members and staff. The IOM aim of safety is addressed within two of the larger goals of the President’s Commission. These include: 1) The understanding that mental health is essential to overall health. 2) That mental healthcare is consumer and family driven. Understanding the IOM Aims Prepared by Ted J. Johnson, M.A.

24. Person-Centered: A highly individualizedcomprehensive approach to assessment and services is used to understand each individual’s and family’s history, strengths, needs and vision of their own recovery including attention to the issues of culture, spirituality, trauma and other factors. Service plans and outcomes are built upon respect for the unique preferences, strengths and dignity of each person. Two specific recommendations from the President’s Commission further elaborate on and address this issue. This includes the call for: 1) An individualized plan of care for adults and children with mental health needs. 2) The involvement of both recipients of care and their families in an orientation towards recovery. Understanding the IOM Aims Prepared by Ted J. Johnson, M.A.

25. Effective: Up -to- date evidence -based services are provided in response to and respectful of individual choice and preference. The aim of effectiveness care is linked to two of the Commission’s goals. These include: 1) The common practice of early mental health screening, assessment and referral for services. 2) Along with the expectation that excellent care is delivered and research is accelerated. Understanding the IOM Aims Prepared by Ted J. Johnson, M.A.

26. Efficient: Human and physical resources are managed in ways that minimize waste and optimize access to appropriate treatment. The IOM aim of efficiency states that health systems should avoid waste, including equipment, supplies, ideas, and energy. There are two goals in the Commission report that support this aim: 1) Mental health care should be consumer and family driven. 2) Technology is used to access mental health care and information. Understanding the IOM Aims Prepared by Ted J. Johnson, M.A.

27. Equitable: Access and quality of care do not vary because of client or family characteristics such as: race, ethnicity, age, gender, religion, sexual orientation, disability, diagnosis, geographic location, socioeconomic status or legal status. The Quality Chasm aim of equity is articulated in three of the Commission’s goals: 1) The elimination of disparities in mental health services, early mental health screening. 2) Assessment and referral services are common practice. 3) The use of technology to access mental health care and information. Understanding the IOM Aims Prepared by Ted J. Johnson, M.A.

28. Timely: Goal-directed services are promptly provided in order to restore and sustain clients and families integration in the community. The aim of timeliness is the focus of two of the Commission’s goals: 1) Americans understand that mental health is essential to overall health. 2) Excellent mental health care is delivered and research is accelerated. Understanding the IOM Aims Prepared by Ted J. Johnson, M.A.

29. Applying Evidence to The Delivery of Healthcare • An average of 17 years for new knowledge to be incorporated into practice • Incorporating new knowledge into practice is uneven and inconsistent • Evidence-based care • Must be a part of any redesign process • Linked to all other areas of the system and any change processes Prepared by Ted J. Johnson, M.A.

30. The Use of Information Technology • Use of technology to improve access and coordination of care • Integration of personal health information • Guidelines for privacy and security of protected health information (HIPAA) Prepared by Ted J. Johnson, M.A.

31. Aligning Payment Policies with Quality Improvement • Accreditation • Clear and consistent vision of quality • Core performance measures Prepared by Ted J. Johnson, M.A.

32. Preparing the Workforce • Quality Chasm Report and the President’s New Freedom Commission • Serious problem in the development and deployment of the professional workforce • Educational systems that prepare the workforce fail to keep pace with changes • System reform will require significant changes in the behavioral health and general healthcare fields Prepared by Ted J. Johnson, M.A.