Question

what are some suggested policies, procedures, guidelines, or reform to imrove the quality of care in U.S. mental health asylums?

Answer 1

What are the major policy recommendations?
Process of deinstitutionalisation and the
development of community-based care should be adopted as major mental health policy goals.
Significant advances can be made in the transition from institutional to community-
based care for people with long-term mental disorders. However, progress has been very uneven across countries and for many there is still much to be done to create community-based mental health service networks and to provide good quality and socially inclusive care.
Therefore, the Joint Action for Mental Health and Wellbeing recommends that Member States develop and implement policies and services to address existing insufficiencies and gaps in European mental health care systems, to promote community-based care and the social inclusion of people with long-
term mental disorders. To achieve this, 12 integrated strategic areas, each one including a group of actions, are recommended.
Recommended strategic areas
1. Developing concerted plans to generate political commitment for mental health system development;
2. Developing/updating mental health policies and legislation;
3. Integrating mental health in primary health care;
4. Shifting the locus of specialized mental health care towards community-based services;
5. Establishing or increasing the number of psychiatric units in general hospitals;
6. Promoting a coordinated transition towards community-based care, to ensure the improvement of quality of care and the protection of human rights across all parts of the system;
7. Ensuring that community psychosocial supports are available for people with severe mental disorders;
8. Developing community-based services and programmes for specific populations;
9. Improving the use and effectiveness of mechanisms to monitor the implementation of mental health reform;
10. Ensuring resources are used effectively to address needs and develop community-based services;
11. Promoting cross-sector cooperation;
12. Promoting the use of relevant instruments.

Main recommended actions:
• Map the key decision makers who can play a significant role in the process of change, and collect information about the organisations that should be approached and invited to become partners in strategies to generate political commitment;
• Monitor the implementation of mental health policy across the country.
• Encourage and promote the revision and updating of mental health policy, based on human rights and the available evidence, in countries where this is needed;
• Promote the revision and updating of mental health legislation, taking into account the principles of recovery and the recommendations from CRPD; Convention on the Rights of Persons with Disabilities (UN Convention on the Rights of Persons with Disabilities (CRPD) | Equality and Human Rights Commission.)

• Promote research and dissemination of collaborative and stepped-care models between primary care and specialist mental health care;
• Promote co-ordination of care and effective follow-up of discharged patients in order to ensure continuity of care;
• Increase knowledge and understanding of mental health disorders among relevantgeneral hospital personnel in an attempt to reduce stigma, discrimination, or misconceptions regarding people with mental disorders;
• Develop and establish a community mental health team in each catchment area;
• Promote the active involvement of users and carers in the delivery, planning and reorganization of services;
• Develop facilities and programmes that have so far been underdeveloped in the country such as integrated programmes with case management, outreach or mobile mental health teams, E-Health, self-help and users and carer groups;
• Develop structured cooperation between mental health services, social services and employment services, to ensure that community-based residential facilities, vocational programmes, and other
psychosocial rehabilitation interventions are available;
• Develop the capacity of mental health leaders to mobilise and steer the implementation of mental
health policies;
• Develop and improve information systems to collect and aggregate data and promote the use of existing data to monitor the impact of policies and services focused on the transition from mental hospitals/psychiatric hospitals to community-based care;
• Develop efficient mechanisms for funding mental health care that are commensurate to the needs of the population; including incentives that promote the development of community-based care;
• Maximise the use of relevant financial programmes, especially Structural and Investment Funds to support the deinstitutionalisation and social inclusion of people with long-term mental disorders.
As the field of mental health treatment is relatively new, the Freedom Commission report recommends more research in order to address the knowledge gaps mentioned above. Experts recommend efforts to increase the use of practices that have been shown to be effective in order to improve the quality of mental health care. Application of the current advances in mental health treatment would require appropriate training for providers. Support for emerging evidence-based
treatment modalities would require changes in financing mechanisms. The IOM report suggests that delays in the application of evidence-based practices may be reduced by the use of quality improvement tools and information technology. In response, Congress could consider requiring HHS and CMS to collaborate with private insurers to encourage the application of emerging research findings into practice through grants and payment incentives. In addition, Congress could consider requiring SAMHSA to work with
accreditation boards to provide more training and continuing education opportunities for
providers to use the latest evidence-based practices and information technology. Congress has appropriated funds to promote the use of information technology in general health care.While this funding may improve reporting on mental health care that is delivered by general health providers, it is not targeted toward specialty mental healthcare provider.

The Surgeon General's report indicates that in order to provide access to quality care for all

individuals with mental illness, the capacity of the mental health care system would need to be increased. The Freedom Commission report recommends that the mental health workforce be developed to support changes in demand for care and treatment options, and that workforce competencies be developed in order to respond to the demand for culturally competent and sufficiently diversified range of services.

Congress could consider addressing this issue by asking the professional associations of health care providers to assess the mental health training needs for mental health providers who work in various settings such as primary care, as well as needs for training in cultural competence for mental health providers. Once the training needs are identified, Congress would have the option of providing funding to SAMHSA to address those needs.

The expanded federal mental health parity law, the Paul Wellstone and Pete Domenici Mental

Health Parity and Addiction Equity Act of 2008,62 requires health insurers who choose to cover mental illness to provide coverage for mental illness on par with that for physical illness.

Research is needed to determine the effectiveness of the new mental health parity requirements in improving mental health coverage. Authors of the four national reports mentioned earlier recommend the need for increased federal support for mental health research. Congress could consider how to improve, for example, leadership and vision, with a public-private partnership that involves federal and state entities, providers, insurers, researchers, and advocates for individuals with mental illnesses. Such leadership at the national level could help illuminate the changes needed to transform the U.S. mental health delivery system.

Experts and advocates for individuals with mental illness recommend patient-centered mental health care that is focused on an individual’s recovery to health. This requires coordination and
integration of mental health care with general health care and other sectors. As recommended by the IOM report, consumers and caregivers need to be more involved in planning for their mental health services, so that it is fully responsive to individual needs and preferences and appropriately
coordinated with other social and rehabilitation activities. In order to address this issue, Congress could consider requiring SAMHSA, working with federal and state agencies that could provide social or health services to individuals with mental illness, to develop a coordinated system of care model. Then, such a model could be adapted to function
at the state or community level. This may be based on SAMHSA’s Systems of Care for children with serious emotional disorders where a wide range of mental health and related services, such as educational services, social services, and substance abuse services, are coordinated to provide care.

A comprehensive strategy that transforms the mental health care delivery system could ultimately lead to improved outcomes for individuals with mental illness. Specifically, the IOM report recommends that the system needs improved diagnostic and assessment strategies, a stronger infrastructure for measuring and reporting the quality of mental health care, and support for quality improvement practices. The IOM report also states that development of mental health information technology infrastructure will help in measurement and improvement of quality of mental health care.

Congress could require providers to develop the systems that are needed to collect data on mental health care quality. In addition, Congress could require SAMHSA to work with national experts to translate the NOMs into recommendations for transforming the system. Finally, Congress could require coordination among federal agencies involved with mental health research, care delivery, and financing.