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Improving Mental Health Care

Commitment to Quality

Edited by Barbara Dickey, Ph.D., and Lloyd I. Sederer, M.D.

  • ISBN 978-0-88048-963-8
  • Item #8963


How can professionals maintain or improve the quality of care they provide when pressured by payers to reduce the cost of care?

Clinicians today face the challenge of providing optimal care in an environment where costs drive clinical practice. But high quality, not cost, remains the goal of professionals. By arming themselves with measurable results, clinicians can improve the processes of delivering mental health care and translate those improvements into better outcomes for patients and their families. In this timely guide, the editors have gathered the work of 49 distinguished contributors and crafted a valuable resource for overcoming the extraordinary challenge of delivering high quality mental health care. This groundbreaking book is divided into three sections:

  • The challenges today’s clinicians face in providing optimal mental health care—Beginning with a review of the report to then-President Clinton from the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, subsequent chapters discuss professional ethics and managed care, how Wall Street investors are changing the practice of medicine, problems faced by managed care, and changes needed in medical education to ensure that physicians are well prepared to practice medicine in the 21st century.
  • Proven techniques for quality measurement—Measuring quality of care presents significant conceptual and methodological problems. These chapters review quality measurement methods and describe support by the federal government to improve these methods. Also addressed are how consumers are joining the quality of care measurement movement and how one large urban county mental health program is advancing quality measurement.
  • Fourteen case reports of quality improvement projects—These chapters detail principles and techniques that can be replicated or tailored to fulfill the requirements of a variety of clinical settings, ranging from the national health service in Great Britain to a small geriatric unit in a large hospital. The work showcased here was done by clinicians or administrators who, concerned about the quality of care in their own settings, used data to test for themselves whether their interventions resulted in improved care.

Even if managed care disappeared, we would still need to question, examine, and improve the quality of patient care—with clinicians taking the lead, because only they can appreciate the subtle nuances that maintain or improve quality standards, and only they can make substantive changes in their clinical settings.

As both a broad conceptual framework for considering the quality of mental health care and as a practical field guide to real-life techniques for measuring the quality of care, this volume will prove exceptionally valuable for mental health care professionals, administrators, and policymakers as well as for consumers and consumer advocates, researchers, students, and public health professionals.


    About the Editors
    Part I: Challenges
    Chapter 1. The President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry
    Chapter 2. Maintaining professional ethics in a changing health care system
    Chapter 3. Quality of care in an era of Wall Street medicine
    Chapter 4. Can managed care deliver quality?
    Chapter 5. Role of academic medical centers in achieving quality
    Part II: Quality Measurement
    Chapter 6. Measuring quality: An overview
    Chapter 7. Risk adjustment of clinical outcome data
    Chapter 8. Building partnerships in accountability: Consumer satisfaction
    Chapter 9. Toward a national report card: Measuring consumer experiences
    Chapter 10. Practical steps toward quality improvement: A public sector example
    Chapter 11. The American Psychiatric Association’s agenda for evidence-based quality
    Chapter 12. Status of national efforts to improve accountability for quality
    Part III: Case Reports
    Chapter 13. Intensive psychiatric community care in the Department of Veteran's Affairs
    Chapter 14. A national strategy to reduce depression and suicide in England
    Chapter 15. The Texas Medication Algorithm Project
    Chapter 16. Improving the quality of community-based services for children
    Chapter 17. Improved emergency access for Medicaid clients: A Colorado case study
    Chapter 18. Improving employment outcomes for people with severe psychiatric disabilities
    Chapter 19. Matching substance abuse patients to services
    Chapter 20. Adverse drug reactions: An interdisciplinary team approach
    Chapter 21. High-risk Medicaid enrollees and a community-based support program
    Chapter 22. Increasing consumer involvement in treatment
    Chapter 23. Improving the detection of mental disorders by primary care clinicians
    Chapter 24. Reducing the incidence of restraint and seclusion
    Chapter 25. Using dialectical behavior therapy in the treatment of borderline personality disorder
    Chapter 26. Reducing the risk of falls for elderly patients

About the Authors

Barbara Dickey, Ph.D., is Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School and The Cambridge Hospital. She has been active in hospital quality improvement efforts and has a long academic career in health services research. She has published widely in the fields of outcome research, homelessness, and the effects of managed care on costs and outcomes for people with serious mental illness. She is leading a research study of the quality of care for adults with schizophrenia, comparing the treatments and outcomes of people in managed care with those whose care is not managed. With Dr. Sederer, she coedited Outcomes Assessment in Clinical Practice.

Lloyd I. Sederer, M.D., was Medical Director and Executive Vice President of McLean Hospital at the time this book was being prepared. In this role, he directed the hospital's clinical services, including its special emphasis on clinical quality assessment and quality improvement. He is now Director of the Division of Clinical Services at the American Psychiatric Association in Washington, D.C. Dr. Sederer is Associate Professor of Clinical Psychiatry at Harvard Medical School and has published 10 books and over 125 articles, reviews, chapters, and monographs. He has consulted nationally and internationally on clinical care and service delivery, quality improvement, risk management, and the regulation and reimbursement of medical care.

Improving Mental Health Care will appeal to a broad audience. It provides both practical guidance and encouragement to anyone interested in systems change and the possibilities for improving care in a difficult practice environment. In a time of brooding pessimism and dangerous passivity, it provides an antidote and a practical model for moving forward into the coming era.—Michael Bennett, M.D., Journal of Clinical Psychiatry, 4/1/2003

Improving Mental Health Care provides a good introduction to the multiple roles that clinicians and managers can adopt to improve care.—Alexander S. Young, M.D., M.S.H.S., Psychiatric Services, 4/1/2003

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