Outcome Measurement in Mental Health: Theory and Practice
A number of necessary lessons can be learned from this well-crafted, scholarly, and internationally oriented text. The book is an around-the-world tour of mental health measurement in fewer than 300 pages. Your journey takes you through three well edited sections: Outcome Measurement Around the World, Outcome Measurement in Specific Groups and Settings, and Current Issues in Outcome Measurement. First, by examining mental health assessment in the United Kingdom and other European countries and in Australia and New Zealand, and by even taking a glimpse at assessment in the United States, we see a reassuring picture of responsible academics, clinicians, and governments making their mental health programs work as cost-effectively as possible. There is even significant agreement among domains to focus upon and measure.
On reading the second section, one realizes there is no cause to break out the champagne, for measuring clinical and functional outcomes, provision of services, experiences of care, and even recovery does not equate to improving the very same. Not that the two are typically and inextricably linked, but they need to be. The adage “what gets measured gets managed” does not seem to apply in so many of the countries, local government programs, and service sites that the editor and authors amply and ably portray. It's not the authors' fault—they are reporting the facts.
Third, and while only implied in this book, the disturbing reality is that we in mental health (and the addictions area) have two vast and fundamental problems: first, people with serious mental illnesses don't seem very often to want what we have to offer, demonstrating this by their low rates of engagement and retention in care; second, for those who actually engage in services, the likelihood that their conditions will be routinely screened for, properly diagnosed, and effectively treated is woeful in most countries and in general medical as well as specialty mental health settings. The science-to-practice gap in the United States reveals that less than 20% of people in need get anything akin to “minimally adequate care.” Oy.
Measuring outcomes is a necessary element in the effort to change the unacceptable. But measurement is far from sufficient. We are bereft of accountable organizations that accept and meet the demanding responsibilities of serving people with serious mental illness in a manner that is focused on what they want in life. This is a population that typically also has substance use disorders and chronic medical disorders (such as cardiovascular disease and diabetes), which strip quality from their lives. We lack payment systems that reward the right things—what consumers and their families seek—rather than paying, as many do, for what is done and, worse, for doing what is not working. We still are too timid about explicitly declaring what effective treatment must be, at least if a clinic license is granted or payment made by the government or insurers for what is done.
The concepts, methods, and tools provided in this concise book will surely come in handy when we have systems of care that can effectively use them.
