Insight Matters
Winter, 2003

Quality Matters: Change Starts With Us
By Dale P. Svendsen, M.D., Medical Director
Ohio Department of Mental Health

The Ohio Department of Mental Health (ODMH) recently launched "Quality Matters," an electronic newsletter primarily directed to mental health clinicians in Ohio. The purpose of the newsletter is to provide a communication forum and to promote clinical excellence.

Is there need for clinical improvement? In November 2002, Mike Hogan, Ph.D., Chairman of the President's New Freedom Commission on Mental Health, and Director of the Ohio Department of Mental Health, cited the need for dramatic reform at all levels of service delivery. "…The Commission's challenge now is to identify realistic solutions to help people with mental illness obtain the quality care that research has shown to be effective. Today people diagnosed with cancer or heart disease benefit from a broad array of effective treatments. People with mental illness deserve no less. Undetected, untreated, and poorly-treated mental disorders interrupt lives, leading many to disability, poverty and long-term dependence. The good news is that recovery from mental illness is a reality; a range of safe and effective treatments, services and supports exists for men, women and children. We know that when mental illness is diagnosed early and treated appropriately, quality of life is tremendously improved. Yet, half of all people who need treatment for mental illness do not receive it. The rate is even lower for racial and ethnic minorities and the quality of care they receive is poorer."

Excellent mental health care for many mental illnesses has been studied and effective approaches have been validated. Cognitive Behavior Therapy for depression and Assertive Community Treatment for people with severe and persisting mental illness are examples. However, there are barriers to implementing these treatments in practice settings and in making sure that people with these disorders have access to these treatments. This newsletter is one of many tools directed to overcoming barriers to ensure that excellent care will be available to the citizens of Ohio.

In addition to the Quality Matters newsletter, my office is also organizing a clinical quality advisory and implementation board. Members include "ambassadors" from each of the statewide professional and clinical mental health disciplines, child and adult advocacy, and family organizations. The Board will have its first quarterly meeting on February 14, 2003. The Board has been asked to advise and assist with the newsletter, provide input on the ODMH Quality agenda and its priorities, and to assist with the implementation of clinical excellence. To my knowledge this will be the first statewide, inclusive, cross-discipline clinical mental health professional group in Ohio.

Will a newsletter and a clinical advisory and implementation board have the desired impact? I believe that the answer is yes. All care occurs between the recipient of care and the provider of direct care. And, if one wants to improve care, one must focus here. By promoting research validated practices and quality tools, and by disseminating these approaches widely, one would expect to have significant impact.

What about trying to do this in these times when money is scarce? From my experience as Medical Director of the Ohio Department of Mental Health over the past 11 years, I can assure you that policy, rules, and payment systems significantly influence care. During times when money is scarce, payment influences may be even greater. But it is when cuts are being contemplated that the voice of the clinical leader must be heard, promoting the best priorities based on efficient, effective, and clinically excellent approaches.

Change starts with us! The ODMH approach to improving Clinical Quality includes our recent work on several approaches that I would like to share with you. Our Quality approach is grounded in a firm belief that people do and can recover from mental illness. For youth who are still in the process of child and adolescent growth and development the focus is on resiliency. We also believe that mental health care and services must be provided in a culturally competent manner. Thus our goal is to prepare clinicians to provide services that are aimed at recovery/resiliency and delivered in a culturally competent manner.

We have been making evidence-based treatment approaches available to persons with mental illness, much like the array of proven treatments that are available for persons with heart disease or cancer.

Outcomes for consumers must also be considered. In our public mental health system, the Ohio Outcomes measures have now been implemented in 43 of 50 board service areas. Twenty-three of those boards are sending their data into the statewide Outcomes database, which now contains about 115,210 records. As Ohio Outcomes measures are implemented around the state we will gain knowledge about what works best and under what circumstances.

Continuous quality improvement is a continuous process that utilizes a group of tools to plan, do, check, act and improve quality. Tools of this nature are used in most of health care and are required by many accrediting organizations. It would be expected for example, that the outcome measures would be analyzed using continuous quality improvement tools.

The Quality Matters newsletter is an effort to improve communication about Quality and Recovery, but it is only a first step. As the New Freedom Commission report states, the "system needs more than a little tweak." To improve clinical quality, our next steps are to engage clinicians and others throughout Ohio to become more involved in the approaches of the Clinical Quality Agenda. Clinicians must show leadership and try out and evaluate these quality approaches and then continue to sustain the most effective approaches. This is major change. It's more than a tweak…and it involves all of us. Quality matters…and change starts with us!

To subscribe to the Quality Matters newsletter, visit http://dmhext01.mh.state.oh.us/dmh/newsletter/qualitymatters.nsf. For more information about ODMH's Clinical Quality Agenda, contact the ODMH Medical Director's office at 614-466-6890.

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