Call for information, call for quality in mental health care

Abstract

The quality of routine mental health care is not optimal, it can vary greatly from region to region and among providers; in many occasions, it does not correspond to the standards of evidence-based mental health. To bridge this gap, the promotion of a systematic use of the information available for quality assurance would be most helpful, but measuring the quality of mental health care is particularly challenging. Quality measurement can play a key role in transforming health care systems, and the routine measurement of quality, using clinical indicators derived from evidence-based practice guidelines, is an important step to this end. In Italy, the use of clinical indicators is still sporadic: over the last 5 years only three projects have been aimed at analysing, in a structured way, the quality of care in severe mental illness, and two of these were led by the Italian Society of Psychiatric Epidemiology. Not only in Italy but also at global level there is an urgent need for the implementation of mental health information systems that could lead to a substantial improvement in information technology. Once this has been achieved, a common set of clinical indicators, agreed upon at the regional and national level and useful for benchmarking and for comparing mental health services, could be defined. Finally, using the implementation strategies, a system of quality improvement at both regional and local levels will be built. First published online 18 December 2012Key words: Clinical indicators, information system, mental health care, quality of care. Quality of care and information: the mental health gapAs the Institute of Medicine pointed out in its influential book Crossing the Quality Chasm (Institute of Medicine, 2001), the last 20 years has seen a chasm occurring between the capacity to develop evidencebased mental health and that of implementing it in day-to-day practice. This means a growing gap between what a patient routinely receives in terms of mental health interventions and what he should receive. As frequently assessed (Lehman et al., 1998;McGlynn et al., 2003; Institute of Medicine, 2006;Lora et al., 2011), the quality of routine mental health care is not optimal, it varies greatly from region to region and among providers, and in many occasions such care does not correspond to the standards that evidence-based mental health puts forward.Also, the information we have on the quality-of-care provided in mental health systems is poor; in fact not only is there a gap in providing good-quality care, but also there is an information gap. There is little knowledge of how severe mental illnesses are treated in most health care systems: in many countries, for most diseases, potential quality problems and their prevalence and incidence are unknown (Mainz, 2003a). The Decision Support 2000 + , the Substance Abuse and Mental Health Services Administration (SAMHSA) program on information needs of the US mental health services, states that the quality of information will determine the quality of care in mental h...

Reduced duration of untreated illness over time in patients with schizophrenia spectrum, mood and anxiety disorders

“…Data on help‐seeking decision and first therapy setting did not show significant differences across epochs of onset, but they revealed that an autonomous decision to seek help tended to be less frequent, compared to that influenced and/or taken by others. This finding stresses the importance of correct and updated information outside the community of patients with mental disorders, in order to facilitate treatment access and implement early intervention programs . Data on first therapy setting simply indicate that the outpatient setting tends to account for approximately four out of five cases, with no difference over time.…”

Thirty-Five Years of Community Psychiatry In Italy

“…Because the National Health Information System is undergoing implementation, in the near future, we should benefit by a core set of indicators helping to evaluate processes and outcomes across regions and providing information on the epidemiological characteristics of regional MH systems (Lora, 2013;Lora et al, 2007).…”

Care pathways in the transition of patients between district psychiatric hospital centres (DPCs) and community mental health services

“…The importance of providing and receiving correct information at the right level and time is described in a previous study, which reviewed evidence on the quality of information transfer between primary care physicians and specialist mental health providers for referral and after inpatient discharge. Previous research has also revealed variability in the quality of protocols in mental health care, with differences existing between regions and among providers and, in some cases, a lack of correspondence between the provided care and the standards of evidence‐based mental health care …”

“…Previous research has also revealed variability in the quality of protocols in mental health care, with differences existing between regions and among providers and, in some cases, a lack of correspondence between the provided care and the standards of evidencebased mental health care. 32 Participants emphasized the need for new evidence-based protocols for the patient discharge process. One staff member succinctly expressed this shared sentiment when she made the following remark:…”