Best practice can be defined as programs, services or processes that research
or expert opinion has shown to be effective. The adult mental health field
continues to evaluate services and seek scientifically supported guidelines
and methodologies for improving cost effectiveness and program quality.
Trends Evolving in the Mental Health System
The Surgeon General's Report on Mental Illness identifies four specific
trends (Figure 7-7) that have evolved in mental health systems over the last
25 years that impact the development of best practices (USDHHS, 1999, p.
13).
Science, the consumer and family involvement movement, range of treatments,
and financing have enabled professionals in the field of mental illness
to evolve the system of care. Today, there are a variety of treatment
options.
However, many of these options are not available to everyone. In order
to develop a plan for the Travis County community, it is essential that
the
mental health service system be efficient and effective, both clinically
and financially. The Surgeon General's report asks the question, "What models
of service delivery are most effective?" Several models are identified by
the landmark report with an emphasis on focusing on the most disabled due
to society's responsibility to ensure those with the most disabling conditions
receive appropriate care. The report finds that there is extensive research
that reflects, "existing service systems are seriously deficient" for those
who are in the greatest need. (USDHHS, 1999, pp. 285-286).
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Surgeon General's Recommendations
The Surgeon General's Report on Mental Illness is an important landmark
in the study of mental health and mental illness. It is important to utilize
the recommendations set forth in the report with our own planning process
in Travis County. The following is a list of the eight recommendations that
were developed in the report to assist the community in its planning efforts
(USDHHS, 1999):
- Continue to build a science base;
- Overcome stigma;
- Improve public awareness of effective treatment;
- Ensure the supply of mental health service providers;
- Ensure delivery of state-of-the-art treatments;
- Tailor treatment to age, gender, race, and culture;
- Facilitate entry into treatment; and
- Reduce financial barriers to treatment.
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Mental Health Service Delivery System
The Surgeon General's Report indicates that an adult mental health service
delivery system would benefit from the following types of services (USDHHS,
1999):
- Case Management;
- Assertive Community Treatment (ACT);
- Psychosocial Rehabilitation;
- Inpatient Psychiatric Hospitalization;
- Community Alternatives for Crisis Services;
- Dual-diagnosis Services; and
- Other Services and Supports (Consumer Self-Help, Consumer-Operated
Programs, Consumer Advocacy, Family Self-Help, Family Advocacy, Human
Services, Housing,
Income, Education, Employment, Health Coverage, Integrating Service
Systems).
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National Alliance for the Mentally Ill (NAMI)
NAMI advocates for the Omnibus Mental Illness Recovery Act and has proposed
a model system of care with eight specific models or best practices (NAMI,
Omnibus Mental Illness).
- Consumer and family member participation in mental illness services
planning;
- Equitable healthcare coverage or parity;
- Access to newer medications;
- Assertive Community Treatment;
- Work incentives for persons with severe mental illness;
- Reduction in the criminalization of persons with severe mental illness;
and
- Access to permanent, safe and affordable housing with appropriate
community-based services.
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