for Mental and Substance-Use Conditions, the “inadequacy of [mental health and substance use] health care is a dimension of the poor quality of all health care” (Institute of Medicine, 2006, p. 8). However, it also points out that care for mental health and substance use problems is also distinct from health care generally. The distinctive features they describe include greater stigma associated with diagnoses, a less developed infrastructure for measuring and improving the quality of care, a need for a greater number of linkages among multiple clinicians, organizations and systems providing care to patients with mental health conditions, less widespread use of information technology, a more educationally diverse workforce, and a differently structured marketplace for the purchase of mental health and substance use health care (Institute of Medicine, 2006). With this in mind, the report recommended using the strategy set forth by another Institute of Medicine report (2001), Crossing the Quality Chasm, as a basic framework to achieve substantial improvements in quality of care, but to tailor it to the distinctive features of mental health and substance use care.

Depression presents a fundamental paradox: it is one of the most prevalent of psychiatric conditions but also one that is highly amenable to treatment, at least in the acute phase. The U.S. Surgeon General, the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, and many others continue to document advances in the understanding of depression, the identification and assessment of depressed individuals, and the development of efficacious treatments, as well as strategies for delivering these interventions effectively. Yet despite recent scientific advances, in 2007, only 64 percent of adults in the United States who had a major depressive episode in the past year received some form of treatment (Office of Applied Studies, 2008). Only approximately 30 percent of depressed adults in community samples reportedly will receive any treatment (Simon et al., 2004). Further, depression in adults is typically discussed as an isolated problem. The focus is rarely on how depression affects parenting and child outcomes; how often it occurs in combination with other parental risks, like substance abuse and trauma; or what kinds of strategies can help to identify, treat, and prevent these negative consequences for parents and their children (Knitzer, Theberge, and Johnson, 2008). The current policy environment does not encourage an identification and treatment strategy with this kind of two-generation developmental lens, nor does it support the dissemination or implementation of the growing body of knowledge about effective interventions.


National surveys exist that describe the rates of depression in adults and indicate disparities as defined by selected population characteristics.

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