Jalie A. Tucker, PhD, chair of APA's Board of Professional Affairs, testified on April 26 before the Institute of Medicine (IOM) on strategies for improving the safety, effectiveness, equity, timeliness, efficiency and delivery of behavioral health services.
The IOM Board on Health Care Services has appointed a committee to examine the application of mental health to recommendations for improving quality and delivery of health care put forth in IOM's 2001 report, "Crossing the quality chasm--a new health system for the 21st century."
Tucker and several other mental health representatives offered their testimony to help the board meet its charge of forming an agenda for mental health. The IOM committee plans to gather testimony from a variety of stakeholders and deliver its report during the summer of 2005. Two APA members--Kimberly Hoagwood, PhD, and Tom Trabin, PhD--are members of the IOM committee.
"The 'Crossing the quality chasm' report has been enormously influential in shaping how policy-makers and others think about the problems in our health-care system," says Geoff Reed, PhD, APA's assistant executive director of professional development. "Providing testimony at the beginning of the process of adapting that report to mental health gives us the opportunity to help the committee frame the issues and, therefore, to have an impact on the positions ultimately taken in the report."
The board's recommendations should support the development of a higher-quality, more accessible, less-stigmatized behavioral health-care system, testified Tucker, a professor of public health at the University of Alabama at Birmingham who primarily studies substance abuse services. In addition, she testified, the nation's health system needs to embrace mental health insurance parity.
"Our overarching objective and the measure of our success will be to reach more of the population in need and to increase the population impact of services for mental health and addictive disorders," Tucker said.
To help achieve this goal, Tucker addressed behavioral health needs in six areas the 2001 report targeted for change:
Patient-centered care. Tucker testified that little is known about how patients find a provider, what influences whether they stay or leave treatment, how their experiences and satisfaction influence outcomes and whether they prefer services that are not developed or widely available--such as telehealth or community-based options that do not require entry into the health-care system. The behavioral health field has lagged behind the health field in pursuing these health-service research questions, Tucker said.
Effectiveness. Tucker said that for health-care systems to be more effective they must better accommodate patients with chronic behavioral health problems such as depression and substance abuse. She also said it's important to have more accessible and continuous interventions available to patients--such as when treating substance abuse and schizophrenia--and greater resources should be allocated for prevalent and costly disorders.
Safety. The IOM report emphasized the need to avoid injuries or harm to patients. Tucker said lapses in confidentiality may jeopardize the goal of providing effective mental health care. Differences between the confidentiality needs and standards of mental health and medical care must be accounted for in record-keeping systems, Tucker said. New confidentiality challenges are created by the advent of electronic medical records and electronic claim submissions, she said.
Timeliness. Tucker said offering "treatment on demand" has become common in harm-reduction programs for substance abuse and HIV prevention and that rapid treatment entry does not result in higher attrition. She also said that the move toward psychologists gaining prescriptive authority is a positive step in helping to increase access to behavioral health care, especially in rural and underserved areas.
Prescriptive authority for psychologists would also help eliminate long waits for patients in accessing care, Tucker added. For example, in New Mexico--before legislators passed a bill granting trained psychologists prescriptive authority--18 psychiatrists were serving 72 percent of the population with waiting times up to five months.
Efficiency. Tucker said that coordinated care between behavioral health and the medical system is crucial to improving the efficiency of care. She added that psychological treatments have been shown to be more effective and far less expensive than alternative medical and surgical treatments in many areas--such as psychological stress-management interventions for patients at high risk for heart disease.
However, the benefits remain mostly untapped due to financial and administrative divisions between the two. Behavioral health and medical professionals could provide more efficient care to patients if they collaborated more on treatment, Tucker said, especially when treating patients with serious, disabling and chronic mental disorders and patients with co-occurring mental health and medical conditions.
Equitable treatment. The 2001 IOM report called for health professionals to provide equitable care despite differences in patients' gender, ethnicity, geographic location and socioeconomic status.
Tucker testified that reducing inequities in behavioral health care requires a knowledge base concerning patterns of use among the population in need. For example, men tend to be underrepresented in clinical samples for health and mental health care and women are often underrepresented in clinical samples for substance abuse services, she noted. These diverging patterns point to the need for more active outreach in select problem areas based on differences related to gender and other demographic, socioeconomic status and geographic variables, Tucker said.
She also said it's important to promote cultural competence among psychologists, such as through policy practice guidelines or conference sessions.
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