This publication produced by the Institute of Medicine identifies the key barriers to effective delivery of behavioral health services and presents a framework for addressing fragmentation and improving the quality of mental health and substance use treatment.
This report was produced by a multi-disciplinary committee of experts in medicine, primary care, substance use treatment, informatics, and racial and ethnic disparities. The topics addressed include: 1) a framework for improving the quality of behavioral health; 2) supporting patient decision-making; 3) bolstering capacity to evaluate programs and employ evidence-based practices; 4) coordinating care between different organizations and professionals; 5) ensuring that larger HIT initiatives are tailored to meet the needs of people with behavioral health disorders; 6) increasing the workforce capacity to meet these needs. The Institute of Medicine discusses four main factors underlying the fragmentation of behavioral health care: 1) the separation of mental health and substance use care from general healthcare; 2) the separation of care provided for mental health and that provided for substance use; 3) society’s reliance on the education, child welfare, and criminal justice systems, and other non-healthcare sectors to secure mental health and substance use services; and 4) the separation of public sector services utilized by people with more severe mental health and substance use illnesses from private sector healthcare. This volume provides a set of approaches and recommendations to overcome these four factors. For instance, the Institute of Medicine calls for a cultural commitment to collaboration and integration among mental health, substance use, and primary care providers, at the individual, organizational, and systematic level. Appendix B provides detailed discussion of federal and state laws regarding confidentiality and the release of healthcare information pertaining to mental health and substance use conditions. It also provides a concise explanation of the layers of confidentiality law that have to be navigated in the course of information sharing, including federal and state constitutional laws and statutes and common organizational policies. Note: The chapters that are most pertinent to justice-health information exchanges, include: Chapter 5 (Coordinating Care for Better Mental, Substance-use, and General Health); Chapter 6 (Ensuring the National Health Information Infrastructure Benefits Persons with Mental and Substance-use Conditions); and Appendix B ("Constraints on Sharing Mental Health and Substance-Use Treatment Information Imposed by Federal and State Medical Records Privacy Laws" by Timothy S. Jost).