The above links will take you to the Center for the Health Professions site.

Centering on … Mental Health

This month The Center for the Health Professions releases its study funded by the California HealthCare Foundation and The California Endowment on the mental and behavioral health care workforce in California. Over the past twenty years, mental health care has made significant strides in achieving parity with physical health care. Increasingly there is an appreciation of the prevalence of mental disease and disabilities in the population. Perhaps more important, there is growing recognition that physical and mental health are intimately related and cannot be artificially separated if we are to achieve positive patient outcomes through a balanced set of prevention and care services. Health plans have also moved their polices and practices to recognize the need for improved and better integrated care services. While financing may still lack exact parity, there appears, nonetheless, movement toward that end and better understanding of the cost effectiveness of treating mental illness in early stages.

There is a great array of health professionals addressing mental and behavioral health care issues. These range from physicians trained as psychiatrists to skilled allied health technicians specializing in mental health care. There is a striking unevenness of information pertaining to training, practice patterns and the number of professionals providing direct patient care. One important conclusion of our study is that if we are to truly move toward parity in service provision, we will need much more definitive workforce information than is currently available.

A more important conclusion is that we may not have a clear picture of the mental and behavioral health care services needed, or an understanding of the best ways to deliver services so that they are both clinically effective and make the most effective use of scarce resources. In the past, we have depended on segments of the health professional community to claim a disease, a body part, age group, or gender and themselves determine what was needed and how best to address the concern at hand. As we look toward expanding mental and behavioral health care services in order to achieve parity, we should also ask some hard questions about which segments of the health care system and which professionals are best suited to provide needed services. Part of the complexity of the mental and behavioral health care community is the rich range of resources and the levels of substitutability of these resources to meet different care and prevention needs: if we asked a psychiatrist to design the best care system it will have her biases, a psychologist will have a different view of the world and a psychiatric nurse practitioner another. Before we can truly achieve parity in mental health and before the next workforce study can honestly conclude that there are enough or too little of any type of provider, we must have an evidence-based picture of what is needed and what works. Such a picture does not exist today, and one is not likely to emerge from the professional turf battles that have raged among mental health professionals over the past few years in California and across the nation. An assessment of what is needed should also look broadly across providers (both mental health and others) technologies, and institutions. It should look inside the current formal system of health care as well as outside to communities, families, and other institutions that may be more effective in promoting the outcomes desired.

Advances toward parity for mental health care have taken a great deal of effort and time. In the economic and budget realities that face all health systems today, public and private, it will serve neither the interests of patients nor the long-term prospects of equal support for parity if a highly variable pattern of care is advanced as the model. There is real opportunity for the professions involved in mental and behavioral health care to work together to share what we know from real evidence, and to create a model of service that best serves consumers' interests, not necessary the interests of individual professional groups. Fairness dictates that equally appropriate and effective services are provided for physical and mental health conditions. Without objective clarification, including the public's perspective of what this may mean for mental health care and how it is to be achieved, parity will be a long time coming.

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