Although science continues to advance our knowledge about the etiology of mental and substance-use problems and illnesses and how to treat them effectively, health care for these conditions—like general health care—frequently is not delivered in ways that are consistent with science, ways that enable improvement and recovery. Moreover, care is sometimes unsafe; more often, it is not delivered at all. This gap between what can and should be and what exists is so large that, as with general health care, it constitutes a “chasm” as defined in the 2001 Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century. Using that report as its template, this report puts forth an agenda for improving the quality of health care for mental and substance-use conditions.


Each year more than 33 million Americans use mental health services or services to treat their problems and illnesses2 resulting from alcohol, inappropriate use of prescription medications, or illegal drugs. Approximately 28 million Americans aged 18 or older (13 percent of this population) received mental health treatment in an inpatient or outpatient setting in 20033 (SAMHSA, 2004a), and more than 6 percent of American children and adolescents aged 5–17 had contact with a mental health professional in a 2-month period according to the 1998–1999 National Health Interview Survey (Simpson et al., 2004). The rates are higher still for adolescents: 20.6 percent of those aged 12–17 (5 million youths) received treatment or counseling for emotional or behavioral problems in 2003 (SAMHSA, 2004a); in addition, more than 3 million Americans aged 12 or older (1.4 percent of this group) reported receiving some kind of treatment during 2003 for a problem related to alcohol or other drug use (SAMHSA,


Whenever possible, this report uses the words “problems” and “illnesses” (as opposed to “disorders”) because “disorder,” as defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), refers to “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (emphasis added) (American Psychiatric Association, 2000:xxxi). The committee’s use of the word “problem” acknowledges that not everyone with a need for mental health care has such significant impairment that it qualifies as a “disorder.” Nonetheless, the word “disorder” appears often in this report because it is used so frequently in the literature.


This figure does not include treatment solely for substance use.

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