More than 33 million Americans seek treatment for mental disorders every year, but due to deficiencies in health care quality and access many do not receive the treatment they need, according to the National Academy of Science's Institute of Medicine. The Institute’s new report, Improving the Quality of Health Care for Mental and Substance-Use Conditions, discusses the personal and national consequences of these deficiencies and proposes strategies for improvement.

Numerous studies have documented a discrepancy between care that is known to be effective and the care that the mentally ill actually receive, the report says. A review of studies published from 1992 through 2000 assessing the quality of care for mental disorders -- which include alcoholism and other forms of drug abuse, bipolar disorder, depression, panic disorder, and psychoses -- found that only 27 percent reported adequate rates of adherence to established clinical practice guidelines. Less than a quarter of patients treated for depression were found to have received care that met minimum standards.

These deficiencies have serious consequences. Together, major depression and substance abuse disorders are the leading causes of disability for American women and the second highest for men, behind heart disease. Moreover, mental disorders are co-morbid with a substantial number of other illnesses, such as heart disease and cancer, and adversely affect the results of treatment. About one-fifth of patients hospitalized for heart attacks, for example, suffer from major depression, and post-heart attack depression roughly triples one's risk of dying from a future attack or other heart condition.

"The report encourages coordination and complete integration of care so that patients who receive substance abuse treatment don't have to go to the other side of the city for general medical care," stated Dr. Paul Appelbaum, director of the Division of Psychiatry, Law and Ethics at Columbia University and a member of the committee that prepared the report. The report’s recommendations include:

• The U.S. Department of Health and Human Services should establish a high-level office to take the lead in coordinating reforms in the mental health care delivery system.

• Establishment of a stronger infrastructure for M/SU care by improving the synthesis and dissemination of effective, evidence-based treatments.

• Enhanced collaboration between mental health services and general health care, as well as between providers of mental health services and their counterparts in the substance abuse field.

• Development of national standards for credentialing and licensing mental illness and substance abuse treatment providers.

• Use of quality measures by government and private purchasers of health care.

• More widespread use of information technology to maintain and distribute medical records, information about quality care, and clinical support systems.