Measuring and improving the quality of mental health care: a global perspective

Abstract

Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.

Project Synergy: co‐designing technology‐enabled solutions for Australian mental health services reform

“…These challenges arise in part from limitations associated with electronic medical record and minimum dataset systems, which are typically divorced from the clinical data generated at the consumer–health professional level . Instead they rely heavily on measures of health system activity (in the case of minimum datasets) or have limited data extraction capability (in the case of electronic medical records).…”

Increasing equity in access to mental health care: a critical first step in improving service quality

“…The field of quality assessment in health care traces its origins back more than 50 years to A. Donabedian's seminal article outlining a framework for understanding quality of care from a health systems perspective 1 . Quality improvement in mental health is a younger enterprise.…”

“…As Kilbourne et al 1 describe, measuring quality of mental health care serves as an important step towards reducing service inequities. However, quality measurement that predominantly focuses on treatment outcomes overlooks individuals with mental health needs who cannot access value-based treatments.…”

Depression in primary care: part 2—management

“…An essential step will be the development of quality measures at the interface of depression and physical health. At present, ratified measures—and indeed clinical guidelines—tend to focus on single conditions, whereas depression often co-occurs with other conditions,175 both physical and psychiatric 176. Work has begun to identify the gaps in the evidence base and prioritize areas of need for the development of quality outcomes, both clinical and personal recovery focused, that could aid primary care professionals in their goal of meeting the physical, psychological, and social needs of their patients with depression 177178…”