Good intentions, but few results: part one in a two-part series about improving the quality of behavioral health services.

So, how can we work our way out of this? The answer, nationally and within states, is to begin the work one project at a time, using consensus-based practice guidelines, training staff, sharing our results with each other, and implementing systemic approaches to support and make the needed practice changes. What is needed is an approach that pushes clinical practice to its boundaries, identifies barriers, and then stands ready to address needed system changes on a local basis. We can't afford to wait for the larger changes in financing and organization of the system to occur.

There are models for the type of systemic change we need. The Pittsburgh Regional Health Initiative and the Institute for Clinical Systems Improvement (in Minneapolis/St. Paul) are examples of important local efforts. One of the broadest efforts, designed to look at the health of the community as a whole, is the Kansas City Area Community Healthcare Initiative. All of these are notable in the collaboration they have created among providers, health plans, academic institutions, government, and business, and it is likely that their systemic approaches have been pivotal in their success. As Daniels et al suggest, these community collaboratives may be a key to the transformation of the behavioral health field. (10)

In part two of this series, I will further examine collaboratives and how to implement them.

Dr. Dougherty has provided consulting services in managing change and improving quality to public and private organizations in health and human services for more than 22 years. His work has centered on developing new strategies for state and county behavioral health systems, managed care procurements, benchmarking, performance measurement, and most recently the implementation of quality improvement collaboratives. To contact Dr. Dougherty, e-mail dickd@dmahealth.com.

References

1. New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. Rockville, Md.: Department of Health and Human Services; 2003. www.mentalhealthcommission.gov.

2. Institute of Medicine. Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, D.C.: National Academies Press; 2005. www.nap.edu/catalog/11470.html#toc.

3. Coleman M, Hedberg S. Promising practices in behavioral health quality and improvement: Summary of key findings and lessons learned. Presentation at the 17th Annual NRI Conference of State Mental Health Agency Services Research. Washington, D.C. 2007. www.nri-inc.org/Conferences/Presentations/2007/Session29.pdf.

4. Elias M. Mentally ill die 25 years earlier, on average. USA Today. May 3, 2007.

5. Whooley MA, Simon GE. Managing depression in medical outpatients. N Engl J Med 2000;343(26):1942-50.

6. Rollman BL, Weinreb L, Korsen N, Schulberg HC. Implementation of guideline-based care for depression in primary care. Adm Policy Ment Health 2006;33(1):43-53.

7. Horgan CM, Merrick EL, Garnick DW, et al. The Provision of Mental Health Services in Managed Care Organizations. Rockville, Md.: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; 2003. http://download.ncadi.samhsa.gov/ken/pdf/sma03-3797/sma03-3797.pdf.

8. Wagner EH, Austin BT, Davis C, et al. Improving chronic illness care: Translating evidence into action. Health Aff 2001;20(6):64-78.

9. Pincus HA, Houtsinger JK, Bachman J, Keyser D. Depression in primary care: Bringing behavioral health care into the mainstream. Health Aff2005;24(1):271-6.

10. Daniels A, Adams N, Dougherty R. Crossing the quality chasm: Reforming behavioral health services through community collaborations. Int J Ment Health 2005;34(1):72-89.

BY RICHARD H. DOUGHERTY, PHD

ABOUT THE AUTHOR

Richard H. Dongherty, PhD, is the CEO of the consulting firm DMA Health Strategies. He is a member of Behavioral Healthcare's Editorial Board.

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