Overarching Recommendation 1. Health care for general, mental, and substance-use problems and illnesses must be delivered with an understanding of the inherent interactions between the mind/brain and the rest of the body.

With respect to the quality of M/SU health care, the committee’s analysis shows that the recommendations set forth in Crossing the Quality Chasm for the redesign of health care are as applicable to M/SU as to general health care. Because of its distinctive features, however, the application of those aims, rules, and redesign strategies to M/SU health care must be specially tailored.

Overarching Recommendation 2. The aims, rules, and strategies for redesign set forth in Crossing the Quality Chasm should be applied throughout M/SU health care on a day-to-day operational basis, but tailored to reflect the characteristics that distinguish care for these problems and illnesses from general health care.

To implement this overarching recommendation and achieve success in quality improvement, the committee proposes that the agenda for change embodied in recommendations 3.1 through 9.2 below be undertaken by clinicians; organizations; health plans; purchasers; state, local, and federal governments; and all other parties involved in M/SU health care.

Foremost, consumers of health care for M/SU conditions face a number of obstacles to patient-centered care that generally are not encountered by consumers of general health care. As mentioned above, the shame, stigma, and discrimination still experienced by some consumers of M/SU services can prevent them from seeking care (Peter D. Hart Research Associates Inc., 1998; SAMHSA, 2004a) and inappropriately nourish doubts about their competence to make decisions on their own behalf (Bergeson, 2004; Leibfried, 2004; Markowitz, 1998; Wright et al., 2000). Moreover, insurance coverage for M/SU treatment is more limited than that for general health care, so it is more difficult to obtain and continue the care needed. Finally, more M/SU than general health care patients are coerced into treatment and subject to questions about whether they should be allowed to make decisions about their care. To address those issues, the committee makes two recommendations:4

Recommendation 3-1. To promote patient-centered care, all parties involved in health care for mental or substance-use conditions should


The committee’s recommendations for improving the quality of M/SU health care are numbered according to the chapter of the main report in which they appear; for example, recommendation 3-1 is the first recommendation in Chapter 3.


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