Medical Practice Variations in Mental Health and Addictions Care

Abstract

This chapter provides an overview of the practice variations in care delivery for mental health and addictive disorders and some of the system-level funding and structural factors that contribute to such variation. Practice variations are described for five populations, along with their expected clinical picture and service needs: Children and adolescents The elderly Severe mental illness Mild/moderate illness Substance use disorders These variations occur in a system-level climate which has been transformed over the past decades because of a fundamental change in how appropriate care is defined. Specifically, Western countries have been shifting from institutional to more community-based care - a process labeled deinstitutionalization. National differences in how services are funded and organized in light of deinstitutionalization are described. Pending gold-standard outcome indicators such descriptions allow more in-depth examination of what the potential drivers for system change are and how different funding and structure configurations might be compared and evaluated.