Ensuring highest-quality care for the cost: coping strategies for mental health providers

Quality of mental health service care: the forgotten pathway from process to outcome

The validity of the concept of outcome depends on a relationship between routine treatment and later health status. Outcome evaluations and audits are very rare in psychiatry. A substantial expansion in epidemiologically based, naturalistic, observational, process-outcome data collection in routine psychiatric practice is essential in order to identify treatment allocation biases and other reasons for unexpected outcomes. Identified causes of undertreatment should lead to locally agreed detailed clinical guidelines. Experimental evaluation should take place in routine clinical practice settings, with change in both process and outcome as the objective. Ultimately, the results of both experimental and observational outcome studies on representative service users should converge, permitting outcomes to be the ultimate arbitrator of quality.

COST-EFFECTIVENESS AND QUALITY OF CARE PROVIDED BY CLINICAL NURSE SPECIALISTS

Clinical nurse specialists in psychiatric-mental health nursing provide primary mental health services to prevent and treat minor mental illnesses and collaborate with physicians to provide mental health services to those with complex mental and/or physical illnesses. CNSs practice in a wide range of settings and in rural and urban areas. Eliminating bureaucratic, attitudinal, legal, and insurance barriers to the services of CNSs in psychiatric mental health nursing can improve access, lower costs, and enhance the quality of mental health delivery systems. Nurses can eliminate some of these barriers. Within bureaucratic organizations, such as hospitals and clinics, nurses can document problems and experiment with collaborative models of practice that make full use of their skills. Nurses must be active participants, including taking on leadership roles, in committees that address changes in patient and health care policies in their organizations. Changing attitudes by educating the public--as well as other health care providers and politicians--about the roles and credentials of nurses is instrumental to removing barriers. Brochures about the roles and credentials of nurses can be prepared and disseminated to patients, civic organizations, other health care providers, and politicians. Nurses should never miss an opportunity to address one of these groups! Demonstrating excellence in nursing practice leaves a lasting impression on patients and other health team members. Implementing innovative approaches to care based on current literature in nursing and related areas is an advanced practice expectation. Further documentation of the impact on cost and quality of care by nurse providers is necessary. Legal and insurance barriers are the most resistant to change.(ABSTRACT TRUNCATED AT 250 WORDS)