TABLE 2-2 Percentage of Clinically Trained Specialty Mental Health Personnel Reporting Solo Practice as Their Primary or Secondary Place of Employment

Discipline

Percentage Reporting Solo Practice

Primary Employment

Secondary Employment

Reporting Year

Psychiatry

37.0

18.0

1998

Psychology

38.0

28.0

2002

Social work

18.5

27.1

2000

Counseling

15.1

21.6

2002

Marriage/family therapy

34.9

28.5

2000

 

SOURCE: Duffy et al., 2004.

no one clinician can retain all the information necessary for sound, evidence-based practice. No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature” (IOM, 2001:25). Clinicians in solo practice must assume all the burden of investigating, analyzing, purchasing, and maintaining decision support technologies, which can be prohibitively expensive when there is no economy of scale to be achieved.

Need to Navigate a Greater Number of Care Delivery Arrangements

As discussed above, the ways in which M/SU and other health care providers are separated are more numerous and complex than is the case for other health care generally. Not only is M/SU care separated from general health care, but health care services for mental and substance-use conditions are separated from each other despite the high rate of co-occurrence of these conditions. Also distinctive are the location of services needed by individuals with more severe mental and substance-use illnesses in public-sector programs apart from private-sector health care, and reliance on the education, child welfare, and juvenile and criminal justice systems to deliver M/SU services for many children and adults. These disconnected care delivery arrangements necessitate numerous patient interactions with different providers, organizations, and government agencies. They also require multiple provider “handoffs” of patients for different services, and the transmittal of information to and joint planning by all these providers, organizations, and agencies if coordination is to occur. Yet effective structures and processes to ensure coordination of care across clinicians and organizations are not in place. This situation is exacerbated by the widespread failure of general medical, mental health, and substance-



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