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Institute of Medicine (US) Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington (DC): National Academies Press (US); 2006.

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Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series.

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Appendix AStudy Process and Committee Membership


The Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders was formed by the Institute of Medicine in March 2004. The committee gathered evidence and conducted its analyses between April 2004 and June 2005. During the seven meetings it held during this period, the committee received testimony from people with mental or substance-use illnesses and their advocates; health care providers and organizations; health plans; purchasers; professional associations; researchers; federal, state, and local governments; and others presenting evidence about the quality of mental and substance-use health care and recommendations for its improvement. (See the acknowledgements section in the front of this report for a listing of those providing testimony.)

During this period, the committee also reviewed leading reports in the mental health and substance-use fields, such as the 1999 Surgeon General's report on mental health, the 2003 report of the President's New Freedom Commission on Mental Health, and the Substance Abuse and Mental Health Services Administration's (SAMHSA) report Changing the Conversation—Improving Substance Abuse Treatment: The National Treatment Plan Initiative. The committee also relied on the efforts of several experts in health care for mental and substance-use conditions who prepared commissioned papers providing the committee with in-depth reviews of several key issues:

  • The impact of mental and substance-related illnesses on decision-making capacity
  • Consumer-directed mental health services
  • Statutory, regulatory, administrative, and other barriers to consumer-directed mental health care
  • Issues in measuring the quality of care for adults and children with mental and substance-use problems and illnesses
  • The experience of the Veterans Health Administration in measuring the quality of care for mental and substance-use conditions
  • The safety of health care for mental and substance-use conditions
  • Legal, policy, and programmatic considerations in patient-centered and self-directed care
  • School-based mental health services
  • Treatment services for mental and substance-use conditions for children involved in child welfare
  • Health care for mental and substance-use conditions and the criminal justice system
  • Improving treatment services for mental and substance-use conditions for children and adolescents in juvenile justice systems
  • Workforce issues in health care for mental and substance-use conditions
  • Constraints on sharing information on treatment for mental and substance-use conditions imposed by federal and state medical records privacy laws

The authors of these papers are listed in the acknowledgements section in the front of this report.

During this time, the committee also performed additional evidence review and analysis pertaining to its charge. Some of the extensive evidence reviewed by the committee came from the specialty mental health and substance-use health care fields, some from health services research and other empirical evidence from general health care, and some from other disciplines. The committee's interdisciplinary review of the evidence was completed in June 2005. A draft report containing the committee's recommendations was completed in July 2005 and was sent for external review in August 2005. The committee finalized the report in October 2005.

With respect to the organization of this report, although the committee used the aims and rules of the Quality Chasm report as its analytic framework, it was not possible to fully organize this report according to those aims or rules, for several reasons. First, there is a great deal of overlap among the aims and rules, as would be expected. The aims are the goals to be achieved; the rules are recommended strategies for achieving those goals. As a result, the rules were often more useful as an analytic approach than were the aims. For example, the aims are silent on the issue of care coordination, whereas care coordination and collaboration are explicitly discussed in the rules. Second, many of the problems that the committee members identified, which became the focus of the report, fit equally well under more than one aim (e.g., lack of care coordination affects the effectiveness, safety, timeliness, efficiency, and even patient-centeredness of care—five of the six aims). Although it was relatively easy to separate out the issues most closely related to patient-centered care (as the committee did in a separate chapter), this did not hold true for the rest of the issues addressed by the committee. More problematic, the solutions to the problems also often addressed more than one aim or rule (e.g., better dissemination of evidence affects effective care, as well as safe and timely care). As a result, organizing the report's chapters by the rules or aims would have resulted in a great deal of redundancy.


Mary Jane England, MD (Chair), graduated from Regis College and Boston University with a medical degree, and began a national and international career as a child psychiatrist, a Harvard University dean, and corporate executive and CEO. She served as commissioner of the Massachusetts Department of Social Services from 1979 to 1983, and later as associate dean and director of the Lucius N. Littauer Master in Public Administration Program at the John F. Kennedy School of Government at Harvard University (1983–1987), and then as president of the Washington Business Group on Health. In 2001 she returned to Regis College to become its ninth and first lay president. Recipient of numerous honors and awards, including honorary degrees from Boston University, the Massachusetts School of Professional Psychology, and the University of Texas, Dr. England is past president of the American Psychiatric Association and the American Women's Medical Association. In 2002 she served as a member of the blue-ribbon task force of professional experts in the new Commission for the Protection of Children in the troubled Archdiocese of Boston. During 2003, she received an ABCD (Action for Boston Community Development) award in Boston for her community service and outstanding contributions to protecting at-risk children and families. In 2004 she received the annual Elizabeth Blackwell Award for a distinguished American woman physician from the American Women's Medical Association.

Paul S. Appelbaum, MD, is A. F. Zeleznik distinguished professor of psychiatry, chairman of the Department of Psychiatry, and director of the Law and Psychiatry Program at the University of Massachusetts Medical School. He is the author of many articles and books on law and ethics in clinical practice, including four that were awarded the Manfred S. Guttmacher Award from the American Psychiatric Association and the American Academy of Psychiatry and the Law. He is past president of the American Psychiatric Association, past president of the American Academy of Psychiatry and the Law, and past president of the Massachusetts Psychiatric Society, and has served as chair of the Council on Psychiatry and Law and of the Commission on Judicial Action for the American Psychiatric Association and as a member of the MacArthur Foundation Research Network on Mental Health and the Law. He is currently a member of the MacArthur Foundation Network on Mandatory Outpatient Treatment. He has received the Isaac Ray Award of the American Psychiatric Association for “outstanding contributions to forensic psychiatry and the psychiatric aspects of jurisprudence,” was Fritz Redlich fellow at the Center for Advanced Study in the Behavioral Sciences, and is a member of the Institute of Medicine (IOM) of the National Academy of Sciences. Dr. Appelbaum is a graduate of Columbia College, received his MD from Harvard Medical School, and completed his residency in psychiatry at the Massachusetts Mental Health Center in Boston.

Seth Bonder, PhD, has an international reputation in the field of systems, policy, and operations analysis. He was a full-time faculty member in the Department of Industrial and Operations Engineering at the University of Michigan until December 1972 and is currently an adjunct professor in that department and an advisor to engineering schools, business schools, and mathematics departments in major universities. Dr. Bonder is the founder and former chairman/CEO of Vector Research, Incorporated, which employed over 400 professionals providing analysis and information technology services to national security, health care delivery, and financial enterprises in the public and private sectors. In recent years he has focused some of his efforts on improving the planning and operations of health care delivery enterprises. Dr. Bonder and his colleagues have developed models of health care delivery enterprises and have used them in prospective analyses of health care system reengineering issues and chronic disease management. He has participated in a number of National Academy of Engineering/Institute of Medicine and National Science Foundation workshops on the use of engineering practices to improve the health care delivery system. He was president of the Operations Research Society of America (ORSA) in 1978–1979 and a vice president of the International Federation of Operational Research Societies from 1985 to 1988. He has been the recipient of numerous awards, including ORSA's George E. Kimball Medal for outstanding lifetime contributions to the profession and the INFORMS President's Award. He is a member of the National Academy of Engineering.

Allen Daniels, EdD, is professor of clinical psychiatry and executive vice chair in the Department of Psychiatry at the University of Cincinnati, College of Medicine. He also is the CEO of University Managed Care, which has two operational units: Alliance Behavioral Care, a regional managed behavioral health care organization, and UC HealthPartners, a medical disease management company. Dr. Daniels also serves as executive director for University Psychiatric Services, a multidisciplinary behavioral group practice. All of these organizations are affiliated with the Department of Psychiatry at the University of Cincinnati. Dr. Daniels is active on a number of boards and professional organizations. In 2002 he chaired the American College of Mental Health Administration's Annual Summit on Translating the Institute of Medicine's Crossing the Quality Chasm Report for Behavioral Healthcare. In 2003 he participated in the Institute of Medicine study, Crossing the Quality Chasm: Priority Areas for Health Care Improvement. Dr. Daniels has published extensively in the areas of managed care and group practice operations, quality improvement and clinical outcomes, and academic health care. He has lectured and consulted both nationally and internationally on these subjects. He is a graduate of the University of Chicago School of Social Services Administration and the University of Cincinnati.

Benjamin Druss, MD, MPH, as the first holder of the Rosalynn Carter chair in mental health at Emory University, is working to build linkages between mental health and broader public health and health policy communities. Prior to serving in this position, he was on the faculty in the Departments of Psychiatry and Public Health at Yale, where he was director of mental health policy studies. Dr. Druss has published more than 50 peer-reviewed articles in journals including the Journal of the American Medical Association, the New England Journal of Medicine, and the Lancet, focusing largely on policy/systems issues related to the interface between primary care and mental health. He has received several national awards for his work, including the 2000 American Psychiatric Association Early Career Health Services Research Award, the 2000 AcademyHealth Article-of-the-Year Award, and the AcademyHealth 2003 Alice S. Hersh New Investigator Award.

Saul Feldman, DPA, at the time of this study, was chairman and CEO of United Behavioral Health (UBH), a subsidiary of United Health Group. UBH arranges for and oversees employee assistance and behavioral health services for more than 23 million people throughout the country. Dr. Feldman is now Chairman Emeritus of UBH. Prior to joining UBH, he was president and CEO of HealthAmerica Corporation of California, a health maintenance organization. Before assuming that position, as an executive at the National Institute of Mental Health, he directed the Staff College, as well as the nation's community mental health and applied services research programs. He has also been a consultant to a number of organizations, including the World Health Organization and Pan American Health Organization. Appointed by the U.S. Secretary of Health and Human Services, he served as a member of the National Advisory Council of the Substance Abuse and Mental Health Services Administration. Currently, he is a member of the MacArthur Foundation Network on Mental Health Policy Research and, as an appointee of the Governor of California, serves as a Commissioner on the State's Mental Health Services Oversight and Accountability Commission. Dr. Feldman has held faculty appointments at a number of universities. He is a founding fellow and former president of the American College of Mental Health Administration and founding editor of Administration and Policy in Mental Health, a professional journal for the behavioral health field. His books, many journal articles, and presentations at professional meetings throughout the world have significantly advanced the state of knowledge in behavioral health. Dr. Feldman holds a graduate degree in psychology and a doctorate in public administration, with a specialization in health service policy.

Richard G. Frank, PhD, is Margaret T. Morris professor of health economics in the Department of Health Care Policy at Harvard Medical School, as well as a research associate with the National Bureau of Economic Research. He received his undergraduate degree in economics from Bard College and his PhD in economics from Boston University. He was previously professor of health policy and management at The Johns Hopkins University and served as a commissioner on the Maryland Health Services Cost Review Commission from 1989 to 1994. Dr. Frank is engaged in research in (1) the economics of mental health care, (2) the economics of the pharmaceutical industry, and (3) the organization and financing of physician group practices. He advises several state mental health and substance-abuse agencies on issues related to managed care and financing of care. He also serves as co-editor for the Journal of Health Economics. Dr. Frank was awarded the Georgescu-Roegen prize from the Southern Economic Association for his collaborative work on drug pricing, the Carl A. Taube Award from the American Public Health Association for outstanding contributions to mental health services and economics research, and the Emily Mumford Medal from Columbia University's Department of Psychiatry. In 2002 Dr. Frank received the John Eisenberg Mentorship Award from National Research Service Awards. He is a member of the Institute of Medicine.

Thomas L. Garthwaite, MD, in 2002, was appointed director and chief medical officer of the County of Los Angeles Department of Health Services, the second-largest county health system in the United States. With an annual operating budget of $3.3 billion and nearly 24,000 employees, the county's health care delivery system includes five hospitals and numerous clinics. In addition, the department is responsible for public health services including disease control and bioterrorism preparedness. Dr. Garthwaite is the first medical doctor to serve as director since the unified Department of Health Services was formally established in 1972. Prior to this, he served as undersecretary for health in the Department of Veterans Affairs (VA). In that capacity, he was the CEO for the nation's largest integrated health care system and oversaw a dramatic 7-year transformation in which the VA provided demonstrably higher quality of care to 930,000 more veterans with 27,000 fewer employees and with a 24 percent lower cost per veteran served. A graduate of Cornell University, Dr. Garthwaite earned his medical degree from Temple University. He completed his internship and residency at the Medical College of Wisconsin Affiliated Hospitals before joining the VA in 1976, and he is board-certified in internal medicine. His VA career included nearly 20 years of experience as a physician and clinical administrator at the Milwaukee VA Medical Center, where he served as the Center's Chief of Staff for 8 years.

Gary Gottlieb, MD, MBA, is president of Brigham and Women's Hospital; chairman of the Partners Psychiatry and Mental Health System; and a professor of psychiatry at Harvard Medical School, a position he has held since 1998. He also serves as president of Brigham and Women's/Faulkner Hospitals and is a member of both organizations' boards of trustees. Prior to joining Partners, he founded the University of Pennsylvania medical center's first program in geriatric psychiatry and developed it into a nationally recognized research, training, and clinical program, later serving as executive vice chair and interim chair of the Department of Psychiatry and as associate dean for managed care for the University of Pennsylvania Health System. In 1994, Dr. Gottlieb became director and CEO of Friends Hospital in Philadelphia, the nation's oldest independent, freestanding psychiatric hospital. He has conducted extensive research and published numerous papers in the fields of geriatric psychiatry and health care policy. He is a past president of the American Association of Geriatric Psychiatry. Dr. Gottlieb received his BS cum laude from the Rensselaer Polytechnic Institute and his MD from the Albany Medical College of Union University, and completed his internship and residency at New York University/Bellevue Medical Center. He received an MBA with distinction in health care administration from the University of Pennsylvania's Wharton Graduate School of Business Administration while serving as a Robert Wood Johnson Foundation clinical scholar.

Kimberly Hoagwood, PhD, is professor of clinical psychology in psychiatry at Columbia University and director of research on child and adolescent services for the Office of Mental Health in the State of New York. In this capacity, she directs all research programs on youth and family service effectiveness and outcomes and implementation of evidence-based practices for the state. Formerly she served as associate director of child and adolescent mental health research within the Office of the Director at the National Institute of Mental Health (NIMH). Dr. Hoagwood was also chief of the Child and Adolescent Services Research Program at NIMH for 10 years. Prior to her appointment at NIMH, she was research program director and state school psychology consultant with the Texas Education Agency, supervising a statewide, multidisciplinary program of research on community-based mental health and educational services for children with serious emotional, behavioral, and developmental disorders. Dr. Hoagwood earned her doctorate in school psychology in 1987 and practiced clinically for 9 years. She has held academic appointments at Pennsylvania State University and the University of Maryland. She has received numerous grants and awards, including the American Psychological Association's Distinguished Contribution Award and the Outstanding Scholar in Education award from the University of Maryland. Among her many publications are articles and books examining the efficacy and effectiveness of child and adolescent services, evidence-based practices and their implementation in children's service systems, national psychotropic medication practices, research ethics, and genetic epistemology in the work of Gabriel Garcia Marquez.

Jane Knitzer, EdD, is a psychologist whose career has addressed policy research and analysis of issues affecting children and families, encompassing mental health, child welfare, and early childhood. A clinical professor of population and family health, she has produced landmark work on children's mental health, including the ground-breaking policy reports Unclaimed Children: The Failure of Public Responsibility to Children and Adolescents in Need of Mental Health Services and At the School House Door: An Examination of Programs and Policies for Children with Behavioral and Emotional Problems. Dr. Knitzer became director of the National Center for Children in Poverty in 2004. She has both master's and doctorate degrees from the Harvard Graduate School of Education and did postdoctoral work in community psychology at the Albert Einstein School of Medicine. She was a fellow at the Radcliffe Bunting Institute and has been on the faculty at Cornell University, New York University, and Bank Street College of Education. She is a member of the New York State Permanent Judicial Commission on Justice for Children and serves on the board of Family Support America. She is a past president of Division 37 Child, Youth, and Family Services of the American Psychological Association and of the American Association of Orthopsychiatry. Among her many awards, Dr. Knitzer was recipient of the first Nicolas Hobbs Award for Distinguished Service in the Cause of Child Advocacy from the American Psychological Association.

A. Thomas McLellan, PhD, is a psychologist at the Philadelphia Veterans Affairs Medical Center, professor of psychiatry at the University of Pennsylvania, and scientific director of the Treatment Research Institute. He was educated at Colgate University, Bryn Mawn College, and Oxford University. He has published more than 300 articles and chapters on addiction research. Dr. McLellan and his colleagues have been developing and evaluating treatments for alcohol and drug dependence, as well as evaluation instruments such as the Addiction Severity Index and the Treatment Services Review. They are currently pursuing such questions as “What are the active and inactive ingredients of treatment?” and “What is the appropriate duration and content of treatment for various types of patients?”

Jeanne Miranda, PhD, is a professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California-Los Angeles (UCLA) and a mental health services researcher who has focused her work on providing mental health care to low-income and minority communities. Her major research contributions have addressed the impact of mental health care for ethnic minority communities, including a trial of treatment of depression in impoverished minority patients at San Francisco General Hospital and a study of care for depression in low-income, minority women screened through county entitlement programs. Dr. Miranda is an investigator in two UCLA centers focusing on improving disparities in health care for ethnic minorities. For these centers, she directs an innovative research study focusing on translating diet and exercise interventions for low-income and minority communities. She was the senior scientific editor of Mental Health: Culture, Race and Ethnicity, a supplement to Mental Health: A Report of the Surgeon General, published August 2001. She holds a PhD in clinical psychology from the University of Kansas and completed postdoctoral training at the University of California-San Francisco. Dr. Miranda was elected to membership in the Institute of Medicine in 2005.

Lisa Mojer-Torres, JD, is an attorney specializing in civil rights and health law, with a subspecialty in representing persons in recovery from substance-use disorders (including stabilized, methadone-maintained patients) who are the victims of employment-related discrimination. She is also an active advocate for consumers of substance-use disorder treatment services, representing this constituency on multiple councils, committees, and boards. Ms. Mojer-Torres is a member of the board of directors of the Alliance Project's Faces and Voices of Recovery Campaign and a member of the editorial board of the Journal of Maintenance in the Addictions. Ms. Mojer-Torres recently completed service as a panelist on Discrimination against Individuals in Treatment/Recovery from Addiction, a collaboration between the American Bar Association and JoinTogether. In 2002, she completed a 4-year appointment to SAMHSA's Center for Substance Abuse Treatment's National Advisory Council. She has also served on two committees of the National Academy of Sciences/Institute of Medicine: the Committee on Federal Regulation of Methadone Treatment and the Committee on Community Based Drug Treatment. She has testified before the U.S. Congress, speaks at numerous conferences, and has appeared in the media and in several educational films. She further shares her expertise as a consultant and field reviewer on several projects and grants. She received the first Public Service Award presented by the National Institute of Drug Abuse in 1996. Ms. Mojer-Torres is a graduate of Boston University and New York University School of Law and is admitted to practice law in New York and New Jersey.

Harold Alan Pincus, MD, is professor and executive vice chairman of the Department of Psychiatry at the University of Pittsburgh School of Medicine. He also is Senior Scientist at the RAND Corporation and directs the RAND–University of Pittsburgh Health Institute and The Robert Wood Johnson Foundation's National Program on Depression in Primary Care. Previously, he was deputy medical director of the American Psychiatric Association (APA) and the founding director of APA's Office of Research, executive director of the American Psychiatric Institute for Research and Education, and cochair of the Work Group to Update the Text of DSM-IV (the Diagnostic and Statistical Manual, fourth edition). He has edited or coauthored 15 books and over 300 scientific publications in health services research; science policy; research career development; and the diagnosis, classification, and treatment of mental disorders. He has been appointed to the editorial boards of nine major scientific journals and was founder and editor of Psychiatric Research Report, a national newsletter on science policy and funding. Dr. Pincus has been a consultant to a variety of federal agencies and private organizations, including the U.S. Secret Service, the John T. and Catherine D. MacArthur Foundation, the Hartford Foundation, the World Health Organization, and the World Psychiatric Association Section on Economics. He graduated from the University of Pennsylvania and received his medical degree from Albert Einstein College of Medicine in New York. He is a recipient of the William C. Menninger Memorial Award of the American College of Physicians for distinguished contributions to the science of mental health, the Health Services Research Senior Scholar Award of the APA, Columbia University's Emily Mumford Award, and the National Institute of Mental Health/APA Vestermark Award for contributions to psychiatric education. Dr. Pincus also maintains a small private practice specializing in major affective disorders and has spent one evening a week for 22 years at a public mental health clinic caring for patients with severe mental illnesses.

Estelle B. Richman's career spans more than 25 years of public service, including her appointment in 2003 as secretary of Pennsylvania's Department of Public Welfare, which provides Medicaid, mental health, and substance-abuse disorder services; child and family services; services to individuals with mental retardation; and numerous other public welfare services. Prior to this she was managing director for the city of Philadelphia, responsible for oversight of 13 city departments. She served as the first director of social services for the city of Philadelphia, leading an initiative to create a more integrated and coordinated health and social services system for children, adults, and families. Philadelphia's Behavioral Health System subsequently was named a winner of the 1999 Innovations in American Government from the Kennedy School of Government, Harvard University. Other positions held by Ms. Richman include the city of Philadelphia's commissioner of public health and deputy commissioner for mental health, mental retardation and substance abuse services; southeast area director for the Office of Mental Health in the Pennsylvania Department of Public Welfare; and assistant director with the Positive Education Program (PEP) in Ohio, a comprehensive day treatment school program for children and adolescents with behavior problems. A nationally recognized expert on issues of behavioral health and children's services, Ms. Richman has been honored for her advocacy efforts by the Alliance for the Mentally Ill, the American Psychiatric Association, and the American Medical Association, among others. She also is the recipient of the 1998 Ford Foundation/Good Housekeeping Award for Women in Government.

Jeffrey H. Samet, MD, MPH, is a graduate of Brandeis University and Baylor College of Medicine and has been a primary care physician in Boston since 1983. He is professor of medicine and social and behavioral sciences at the Boston University Schools of Medicine and Public Health and chief of the Section of General Internal Medicine at the medical school and Boston Medical Center, as well as vice chair for public health of the Department of Medicine. In 1995 he became medical director of the Substance Abuse Prevention and Treatment Services Division of the Boston Public Health Commission. Between 1990 and 2002, he served as director of the HIV Diagnostic Evaluation Unit at Boston City Hospital/Boston Medical Center, a weekly intake clinic for newly diagnosed HIV-infected patients. He was national president (1999–2001) of the Association of Medical Education and Research in Substance Abuse and cochair (1992–2002) of the Society of General Internal Medicine Substance Abuse Task Force, and he is currently program chair of the Annual Medical-Scientific Conference of the American Society of Addiction Medicine. He has been principal investigator of two National Institute of Drug Abuse (NIDA)–funded studies and four National Institute on Alcohol Abuse and Alcoholism (NIAAA)–funded studies, including Enhanced Linkage of Drug Abusers to Primary Medical Care and Enhanced Linkage of Alcohol Abusers to Primary Care. He is the primary mentor for two NIDA and one NIAAA career development awardees. He has directed two Center of Substance Abuse Prevention physician faculty development programs and has published over 100 peer-reviewed articles and numerous book chapters.

Tom Trabin, PhD, MSM, is an independent consultant to trade associations, government agencies, organizations, and systems of care within the behavioral health care field. He is the lead organizer of the 2005 National Summit on Defining a Strategy for Behavioral Health Information Management and Its Role in the National Health Information Infrastructure. He organizes and chairs the annual California Information Management Conference for state and county mental health and substance-abuse agencies and treatment provider organizations and for 10 years chaired Behavioral Informatics Tomorrow, the largest trade show of its kind. He helped found and is part-time executive director of SATVA, the trade association of behavioral health software vendors. He leads the adult mental health initiative for SAMHSA's Forum on Performance Measures and the performance measure set and evidence-based practices modules for SAMHSA's Decision Support 2000+. Dr. Trabin represents the behavioral health care field on the Healthcare Information Management and Systems Society's Davies Awards Committee for best implementation of an electronic health record. He has over 60 publications, including several books, book chapters, and articles on performance and outcome measurement and computerization in the behavioral health care field. Previously Dr. Trabin worked in executive positions for U.S. Behavioral Health, Abbott Northwestern Hospital, a behavioral health, and a conference and publishing company. He has worked as a clinician in diverse settings, including a state mental hospital, Veterans Affairs medical center, county mental health center, hospital-based behavioral medicine clinic, partial hospital program, private group practice, and solo independent practice. He earned masters and doctorate degrees in counseling psychology from the University of Minnesota, a masters degree in management science from Stanford Business School as a Bush Leadership Fellow, and a masters degree in philosophy from Delhi University.

Mark D. Trail is chief of Medical Assistance Plans in the Department of Community Health for the State of Georgia. As director of the state Medicaid agency, he is responsible for all Medicaid functions and services, as well as the State Children's Health Insurance Program, PeachCare for Kids. The combined programs provide health care coverage to over 1.6 million Georgians, with expenditures approaching $6 billion. He has worked for over 27 years in a variety of health care fields, serving in both the public and private sectors. While serving as Medicaid director, Mr. Trail implemented a successful conversion from the outpatient clinic option to the rehabilitation option for people with mental illness and addictive diseases. The conversion provided for the payment and development of assertive community treatment teams, peer support counselors, and certain residential services. Prior to his work with Medicaid, Mr. Trail worked in a variety of positions in the mental health, developmental disability, and addictive disease fields. He has been a member and leader of multiple organizations, including serving as president of the National Association of County Behavioral Health Directors. He currently serves on the executive committee of the National Association of State Medicaid Directors. Mr. Trail received a masters degree in community counseling from Georgia State University.

Sr. Ann Catherine Veierstahler, RN, SCSJA, has had a life-long struggle with mental illness that has been featured in both newspapers and magazines. Although her professional life has included working as a registered nurse in a refugee camp in Cambodia with the Red Cross, serving as a nursing home administrator, starting the first clinics for the homeless in Milwaukee, and creating programs to meet the needs of persons with mental illnesses in boarding homes, her own mental illness of rapid-cycling bipolar disorder, present since age 7, was not correctly diagnosed and treated for decades. On her fiftieth birthday, she was diagnosed with stomach cancer. She has since fully recovered from that illness and devotes much of her time and skills to a website ( This website contains stories of individuals' successes despite the many challenges of mental illnesses in order to offer hope to persons still struggling with such illnesses and to help overcome the stigma they experience by educating the public. She also is developing and expanding consumer-run Faith in Recovery support programs in several local faith communities. As a member of Al-anon for many years, Sr. Ann Catherine uses the 12-step program in her own life and knows first-hand the challenges of addictive behaviors. She has received many awards for her outstanding programs and innovations in empowering people to meet their needs and lead enriching and meaningful lives. Among her awards are the Mental Health Association Consumer Advocacy Award and several awards from the National Alliance on Mental Illness (NAMI) including the Adult Services Award.

Cynthia Wainscott is chair of the National Mental Health Association and serves on the Governor's Mental Health, Mental Retardation and Substance Abuse Advisory Council and the state's Mental Health Planning and Advisory Council in Georgia. She also is the consumer representative on the Georgia Medicaid agency's Drug Utilization Review Board and has served on the Center for Mental Health Services' National Mental Health Advisory Council. She has 16 years of experience as a leader in mental health education and has directed a pilot site for the National Institute of Mental Health's Depression: Awareness, Recognition and Treatment program, as well as provided training for model education program nationwide. Her passion for mental health advocacy is fueled by the experiences of her mother, daughter, and granddaughter, who have all lived successfully with mental illnesses.

Constance Weisner, MSW, DrPH, is professor, Department of Psychiatry, University of California-San Francisco, and investigator, Division of Research, Northern California Kaiser Permanente. She has an MSW from the University of Minnesota and a doctorate in public health from the University of California-Berkeley. She directs a research program addressing access to, outcomes of, and cost-effectiveness of alcohol and drug treatment and co-occurring disorders in public and private settings. She is a member of the International Expert Advisory Group on Alcohol and Drug Dependence of the World Health Organization, the National Advisory Council of the National Institute on Drug Abuse, and the MacArthur Foundation Research Network on Mental Health and the Law. She has also been a member of the National Advisory Council of the Center for Substance Abuse Treatment. She has participated on several Institute of Medicine committees, including Broadening the Base of Alcohol Treatment and Managing Managed Care. She is a member of the Washington Circle, developing performance indicators for alcohol and drug identification and treatment in health plans. She has received merit awards from the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Drug Abuse, and works closely with chemical dependency programs on policy issues and in developing best practices. Her ongoing work focuses on the changing systems for receiving health, chemical dependency, and mental health services.

Copyright © 2006, National Academy of Sciences.
Bookshelf ID: NBK19825


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