(e.g., school counselors, pastoral counselors, guidance counselors, and drug and alcohol counselors), each with differing education and training.

The effect on clinical practice of this variation in provider types and in the corresponding education and training is unknown; however, variation in the education and training of different types of physicians who deliver care for mental illnesses has been shown to result in variations in the quality of care (Young et al., 2001). Also, although many different therapies have been developed for M/SU problems and illnesses (see Chapter 4), there is no mechanism in place to ensure that any given clinician has been adequately educated and trained to offer any specific therapy. Such a process is essential to the delivery of safe, effective, and efficient care. The wider variety of provider types also has implications for the ability to provide consumers with the information they need to select a clinician to help them—a key element of patient-centered care—as it is difficult to provide consumers with information on the competencies of any individual practitioner and to guarantee a uniform, safe level of abilities across all types of clinicians.

In spite of this, no mechanisms exist for routinely capturing adequate information on the characteristics of the M/SU workforce comparable to, for example, the National Sample Survey of Registered Nurses regularly conducted by the National Advisory Council on Nurse Education and Practice. Moreover, administrative data routinely collected as part of health care claims or billing do not include a code for provider type. Although it may not be necessary to capture this information in general health care, in which the great majority of billing clinicians are physicians, the failure to do so for M/SU services neglects a substantial opportunity to learn about the M/SU workforce and its patterns of care. The Substance Abuse and Mental Health Services Administration (SAMHSA) has organized periodic efforts to collect data on mental health practitioners (see Table 7-1) (Duffy et al., 2004), but the information collected is incomplete, collected inconsistently across professions, and insufficient for policy and workforce analysis. This and the few other available data sources provide only limited information about specialty and general health care clinicians providing M/SU treatment services.

Specialty Mental Health Providers

Specialty mental health providers include psychiatrists, psychologists, and psychiatric nurses possessing formal graduate degrees in mental health. They also include social workers, counselors, nurses, and therapists who either have received additional, specialized training in treating mental problems and illnesses prior to their professional practice, or have chosen to practice in a mental health care setting and gained advanced knowledge in treating mental problems and illnesses through experience (West et al.,



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