As a result of ACMHA leadership, there was a convergence of support from many sectors for adapting the Quality Chasm framework to M/SU health care. With support from the Annie E. Casey Foundation, the CIGNA Foundation, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, The Robert Wood Johnson Foundation, SAMHSA within the U.S. Department of Health and Human Services, and the Veterans Health Administration of the U.S. Department of Veterans Affairs, the IOM was given the following charge:

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 in 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 carry out this charge, in 2004 the IOM convened a multidisciplinary committee of experts in mental, substance-use, and general health care; public- and private-sector M/SU health care delivery; primary care; consumer issues; integration of service; ethics; economics; Medicaid; racial and ethnic disparities in care; veterans’ health and health care; child M/SU health care; geriatrics; informatics; and systems engineering (see Appendix A for the biographical sketches of committee members). This report is the result of their efforts.

As the committee’s charge and expertise indicate, the scope of this study was large, encompassing both public and private sectors, children and adults, and health care for mental and substance-use problems and illnesses. In particular, addressing health care for both mental and substance-use conditions in a single report was challenging; major public-and private-sector initiatives and reports have nearly always addressed only one or the other (DHHS, 1999; New Freedom Commission on Mental Health, 2003). Nonetheless, the committee found this dual focus to be appropriate and invaluable to its analysis of the evidence and formulation of policy recommendations, given the interconnected nature of these conditions and the resulting need for coordinated policy and care delivery. Indeed, the committee believes that in future initiatives to improve the quality of M/SU health care, expertise in health care for both mental and substance-use conditions should always be at the table.



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