1. Transforming the Mental Health System
Linking General Health and Mental Health:
Considerations from Two Reports
1/3/2019
Prepared by Ted J. Johnson, M.A.

2. Prepared by Ted J. Johnson, M.A.
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
1/3/2019
Prepared by Ted J. Johnson, M.A.

3. Prepared by Ted J. Johnson, M.A.
Overview
Consensus
Current health systems do not work
Current health systems are in need of fundamental reform
1/3/2019
Prepared by Ted J. Johnson, M.A.

4. Prepared by Ted J. Johnson, M.A.
Quality Chasm Series
Produced by
Institute of Medicine
2000 – 2003
1/3/2019
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
1/3/2019
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
1/3/2019
Prepared by Ted J. Johnson, M.A.

7. Obstacles to Quality Mental 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
1/3/2019
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
1/3/2019
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
1/3/2019
Prepared by Ted J. Johnson, M.A.

10. Prepared by Ted J. Johnson, M.A.
Institute of Medicine
Core values for healthcare:
Safe
Person-centered
Efficient
Effective
Timely
Equitable
1/3/2019
Prepared by Ted J. Johnson, M.A.

11. Prepared by Ted J. Johnson, M.A.
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
1/3/2019
Prepared by Ted J. Johnson, M.A.

12. Prepared by Ted J. Johnson, M.A.
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
1/3/2019
Prepared by Ted J. Johnson, M.A.

13. Prepared by Ted J. Johnson, M.A.
Four Levels = Focus of Change Berwick, D.M A User’s Guide for the IOM’s ‘Quality Chasm’ Report. Health Affairs (Millwood) 21 (3):80-90
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
1/3/2019
Prepared by Ted J. Johnson, M.A.

14. Institute of Medicine Quality 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
1/3/2019
Prepared by Ted J. Johnson, M.A.

15. New Freedom Commission Goals and Objectives
1. Americans understand that mental health is essential to overall health.
1.1 Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
1.2 Address mental health with the same urgency as physical health.
2. Mental health is consumer and family driven.
2.1 Develop an individualized plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
2.2 Involve consumers and families fully in orienting the mental health system toward recovery.
2.3 Align relevant Federal Programs to improve access and accountability for mental health services.
2.4 Create a comprehensive State mental health plan.
2.5 Protect and enhance the rights of people with mental illness.
1/3/2019
Prepared by Ted J. Johnson, M.A.

16. New Freedom Commission Goals and Objectives
3. Disparities in mental health services are eliminated.
3.1 Improve access to quality care that is culturally competent.
3.2 Improve access to quality care in rural and
geographically remote areas.
4. Early Mental Health Screening, Assessment, and Referral to Services are Common Practice.
4.1 Promote the mental health of young children.
4.2 Improve and expand school mental health programs.
4.3 Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies.
4.4 Screen for mental disorders in primary health care across the life span, and connect to treatment and supports.
1/3/2019
Prepared by Ted J. Johnson, M.A.

17. New Freedom Commission Goals and Objectives
5. Excellent Mental Health Care is Delivered and Research is Accelerated.
5.1 Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illness.
5.2 Advance evidence-based practices using dissemination and demonstration projects and create a public –private partnership to guide their implementation.
5.3 Improve and expand the workforce providing
evidence-based mental health services and supports.
5.4 Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care.
1/3/2019
Prepared by Ted J. Johnson, M.A.

18. New Freedom Commission Goals and Objectives
6. Technology is used to access mental health care and information.
6.1 Use health technology and telehealth to improve access and coordination of mental health care especially for Americans in remote areas or in underserved populations.
6.2 Develop and implement integrated electronic health record and personal health information systems.
1/3/2019
Prepared by Ted J. Johnson, M.A.

19. Comparing IOM with President’s New Freedom Commission
IOM Aims
Commission Recommendations
Safe
1.1 Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
2.5 Protect and enhance the rights of people with mental illness.
Person-Centered
2.1 Develop an individualized plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
2.2 Involve consumers and families fully in orienting the mental health system toward recovery.
1/3/2019
Prepared by Ted J. Johnson, M.A.

20. Comparing IOM with President’s New Freedom Commission
IOM Aims
Commission Recommendations
Effective
4.2 Improve and expand school mental health programs.
4.3 Screen for co-occurring mental and substance abuse disorders and link with integrated treatment strategies.
4.4 Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports.
5.2 Advance evidence-based practices using dissemination and demonstration projects and create a public -private partnership to guide their implementation.
5.3 Improve and expand the workforce providing evidence-based mental health services and supports.
5.4 Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care.
1/3/2019
Prepared by Ted J. Johnson, M.A.

21. Comparing IOM with President’s New Freedom Commission
IOM Aims
Commission Recommendations
Efficient
2.3 Align relevant Federal Programs to improve access and accountability for mental health services.
2.4 Create a comprehensive State mental health plan.
6.2 Develop and implement integrated electronic health record and personal health information systems.
Equitable
3.1 Improve access to quality care that is culturally competent.
3.2 Improve access to quality care in rural and geographically remote areas.
4.1 Promote the mental health of young children.
6.1 Use health technology and telehealth to improve access and coordination of mental health care especially for Americans in remote areas or in underserved populations.
1/3/2019
Prepared by Ted J. Johnson, M.A.

22. Comparing IOM with President’s New Freedom Commission
IOM Aims
Commission Recommendations
Timely
1.2 Address mental Health with the same urgency as physical health.
5.1 Accelerate research to promote recovery and resilience and ultimately to cure and prevent mental illness.
1/3/2019
Prepared by Ted J. Johnson, M.A.

23. Understanding the IOM Aims
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.
1/3/2019
Prepared by Ted J. Johnson, M.A.

24. Understanding the IOM Aims
Person-Centered:
A highly individualized comprehensive 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.
1/3/2019
Prepared by Ted J. Johnson, M.A.

25. Understanding the IOM Aims
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.
1/3/2019
Prepared by Ted J. Johnson, M.A.

26. Understanding the IOM Aims
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.
1/3/2019
Prepared by Ted J. Johnson, M.A.

27. Understanding the IOM Aims
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.
1/3/2019
Prepared by Ted J. Johnson, M.A.

28. Understanding the IOM Aims
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.
1/3/2019
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
1/3/2019
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)
1/3/2019
Prepared by Ted J. Johnson, M.A.

31. Aligning Payment Policies with Quality Improvement
Accreditation
Clear and consistent vision of quality
Core performance measures
1/3/2019
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
1/3/2019
Prepared by Ted J. Johnson, M.A.