Left behind by reform: the case for improving primary care and mental health system services for people with moderate mental illness.
In this paper, we present a case for improving services to meet the needs of people with moderate mental illness (MMI). We begin by outlining the evolution of mental health reform and its current tendency toward excluding this population. We offer a working definition for MMI and systematically explain why individuals with moderate mental illnesses deserve increased attention and resources within both the mental health system and general medical settings. Some of the 'best practices' on a strategic programme level that can be used to serve people with MMI most effectively are discussed. Making MMI a priority involves reorienting clinical as well as programmatic approaches to address the needs of the population with these disorders. Systems-level financial, structural and manpower supply issues are crucial; challenging government to become a key player in developing a more collaborative model of physical and mental health care. Private health and mental health organisations, professional groups and individual users of services must also commit themselves to recognising the problem of MMI and respond to it more effectively.
Dewa
Carolyn S
CS
Centre for Addiction and Mental Health, Clarke Site, Health Systems Research and Consulting Unit, 250 College St, Toronto, Ontario M5T IR8, Canada. carolyn_dewa@camh.net
Rochefort
David A
DA
Rogers
Joy
J
Goering
Paula
P
D003362:Cost-Benefit Analysis; D018166:Health Care Reform; D006801:Humans; D001523:Mental Disorders / Q000145:classification / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000592:standards*; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D011785:Quality Assurance, Health Care; D014481:United States