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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Adult Mental Health Home Page
