Health and Human Services, and the Veterans Health Administration of the U.S. Department of Veterans Affairs charged the IOM as follows:

Crossing the Quality Chasm: A New Health System for the 21st Century identified six dimensions in which the United States health system functions at far lower levels than it should (i.e., safety, effectiveness, patient-centeredness, timeliness, efficiency and equity) and concluded that the current health care system is in need of fundamental change. The IOM is to explore the implications of that conclusion for the field of mental health and addictive disorders, and identify the barriers and facilitators to achieving significant improvements along all six of these dimensions. The committee will examine both environmental factors such as payment, benefits coverage and regulatory issues, as well as health care organization and delivery issues. Based on a review of the evidence, the committee will develop an “agenda for change.”

To respond to this charge, IOM convened the Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. This report presents the committee’s analysis of the issues and of how the distinctive features of M/SU health care should be addressed in quality improvement initiatives.


Despite the quality problems shared with health care generally, M/SU health care is distinctive in significant ways. Those distinctive features include the greater stigma attached to M/SU diagnoses; more frequent coercion of patients into treatment, especially for substance-use problems and conditions; a less developed infrastructure for measuring and improving the quality of care; the need for a greater number of linkages among the multiple clinicians, organizations, and systems providing care to patients with M/SU conditions; less widespread use of information technology; a more educationally diverse workforce; and a differently structured marketplace for the purchase of M/SU health care.

Despite these and other differences, the committee found that M/SU health care and general health care share many characteristics. Moreover, evidence of a link between M/SU illnesses and general health (and health care) is very strong, especially with respect to chronic illnesses and injury (Katon, 2003; Kroenke, 2003). The committee concludes that improving the nation’s general health and resolving the quality problems of the overall health care system will require attending equally to the quality problems of M/SU health care. Accordingly, the committee offers two overarching recommendations.

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