Abstract
Recovery is the guiding vision of mental health systems and policy. However, skepticism has emerged about whether the paradigm can achieve its sought goals. We argue that embedding recovery within a quality improvement framework, such as the Triple Aim, would increase leverage for systems change and advance recovery practice. The Triple Aim’s goals of improving healthcare outcomes, quality, and costs are pertinent to mental health systems, although action is also needed to address the social determinants of health. Accordingly, we propose the recovery-oriented Triple Aim, which could be used to guide policy development and evaluation of mental health services.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barrett, B., Young, M. S., Teague, G. B., Winarski, J. T., Moore, K. A., & Ochsorn, E. (2010). Recovery orientation of treatment, consumer empowerment, and satisfaction with services: A mediation model. Psychiatric Rehabilitation Journal,34, 153–156. https://doi.org/10.2975/34.2.2010.153.156.
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs,27, 759–769. https://doi.org/10.1377/hlthaff.27.3.759.
Braslow, J. T. (2013). The manufacture of recovery. Annual Review of Clinical Psychology,9, 781–809. https://doi.org/10.1146/annurev-clinpsy-050212-185642.
Bryan, S., & Donaldson, C. (2016). Taking triple aim at the triple aim. Healthcare Papers,15, 25–30.
Chong, H. Y., Teoh, S. L., Wu, D. B.-C., Kotirum, S., Chiou, C.-F., & Chaiyakunapruk, N. (2016). Global economic burden of schizophrenia: A systematic review. Neuropsychiatric Disease and Treatment,12, 357–373. https://doi.org/10.2147/ndt.s96649.
Davidson, L., Ridgway, P., Wieland, M., & O’Connell, M. (2009). A capabilities approach to mental health transformation: A conceptual framework for the recovery era. Canadian Journal of Community Mental Health,28, 35–46. https://doi.org/10.7870/cjcmh-2009-0021.
Davidson, L., Rowe, M., Tondora, J., O’Connell, M. J., & Lawless, M. S. (2008). A practical guide to recovery-oriented practice: Tools for transforming mental health care. New York: Oxford University Press.
Davidson, L., & White, W. (2007). The concept of recovery as an organizing principle for integrating mental health and addiction services. Journal of Behavioral Health Services and Research,34, 109–120. https://doi.org/10.1007/s11414-007-9053-7.
De Hert, M., Correll, C. U., Bobes, J., Cetkovich-Bakmas, M., Cohen, D., Asai, I., et al. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry,10, 52–77. https://doi.org/10.1002/j.2051-5545.2011.tb00014.x.
Ellison, M. L., Belanger, L. K., Niles, B. L., Evans, L. C., & Bauer, M. S. (2018). Explication and definition of mental health recovery: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research,45, 91–102. https://doi.org/10.1007/s10488-016-0767-9.
Farmanova, E., Kirvan, C., Verma, J., Mukerji, G., Akunov, N., Phillips, K., et al. (2016). Triple aim in Canada: Developing capacity to lead to better health, care and cost. International Journal for Quality in Health Care,28, 830–837. https://doi.org/10.1093/intqhc/mzw118.
Frederick, T., Tarasoff, L. A., Voronka, J., Costa, L., & Kidd, S. (2017). The problem with “community” in the mental health field. Canadian Journal of Community Mental Health,36, 3–32. https://doi.org/10.7870/cjcmh-2017-030.
Government of Ontario. (2019). A healthy Ontario: Building a sustainable health care system, 2nd report from the premier’s council on improving healthcare and ending hallway medicine. Toronto: Queen’s Printer for Ontario.
Green, C. A., Perrin, N. A., Leo, M. C., Janoff, S. L., Yarborough, B. J. H., & Paulson, R. I. (2013). Recovery from serious mental illness: Trajectories, characteristics, and the role of mental health care. Psychiatric Services,64, 1203–1210. https://doi.org/10.1176/appi.ps.201200545.
Hopper, K. (2007). Rethinking social recovery in schizophrenia: What a capabilities approach might offer. Social Science and Medicine,65, 868–879. https://doi.org/10.1016/j.socscimed.2007.04.012.
Insel, T. R. (2008). Assessing the economic costs of serious mental illness. American Journal of Psychiatry,165, 663–665. https://doi.org/10.1176/appi.ajp.2008.08030366.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: The National Academies Press. https://doi.org/10.17226/10027.
Katsakou, C., Bowers, L., Amos, T., Morriss, R., Rose, D., Wykes, T., et al. (2010). Coercion and treatment satisfaction among involuntary patients. Psychiatric Services,61, 286–292. https://doi.org/10.1176/ps.2010.61.3.286.
Kidd, S. A., McKenzie, K. J., & Virdee, G. (2014). Mental health reform at a systems level: Widening the lens on recovery-oriented care. Canadian Journal of Psychiatry,59, 243–249. https://doi.org/10.1177/070674371405900503.
Kurdyak, P., Wiesenfeld, L., & Sockalingam, S. (2016). Choosing wisely? Let’s start with working wisely. Canadian Journal of Psychiatry,61, 25–28. https://doi.org/10.1177/0706743715621259.
Laderman, M. (2015). Behavioral health integration: A key component of the triple aim. Population Health Management,18, 320–322. https://doi.org/10.1089/pop.2015.0028.
Lora, A., Conti, V., Leoni, O., & Rivolta, A. L. (2011). Adequacy of treatment for patients with schizophrenia spectrum disorders and affective disorders in Lombardy, Italy. Psychiatric Services,62, 1079–1084. https://doi.org/10.1176/appi.ps.62.9.1079.
Mery, G., Majumder, S., Brown, A., & Dobrow, M. J. (2017). What do we mean when we talk about the triple aim? A systematic review of evolving definition and adaptations of the framework at the health system level. Health Policy,121, 629–636. https://doi.org/10.1016/j.healthpol.2017.03.014.
Mitchell, A. J., Malone, D., & Doebbeling, C. C. (2009). Quality of medical care for people with and without comorbid mental illness and substance misuse: Systematic review of comparative studies. British Journal of Psychiatry,194, 491–499. https://doi.org/10.1192/bjp.bp.107.045732.
National Health Service. (2014). NHS five year forward view. Retrieved June 14, 2019 from https://www.england.nhs.uk/publication/nhs-five-year-forward-view/.
National Health Service. (2017). Next steps on the NHS five year forward view. Retrieved June 14, 2019 from https://www.england.nhs.uk/publication/next-steps-on-the-nhs-five-year-forward-view/.
New Zealand Minister of Health. (2016). New Zealand health strategy: Future directions. Wellington, New Zealand: Author.
Newman, D., O’Reilly, P., Lee, S. H., & Kennedy, C. (2015). Mental health service users’ experiences of mental health care: An integrative literature review. Journal of Psychiatric and Mental Health Nursing,22, 171–182. https://doi.org/10.1111/jpm.12202.
Obucina, M., Harris, N., Fitzgerald, J. A., Chai, A., Radford, K., Ross, A., et al. (2018). The application of triple aim framework in the context of primary healthcare: A systematic literature review. Health Policy,122, 900–907. https://doi.org/10.1016/j.healthpol.2018.06.006.
Pincus, H. A., Spaeth-Rublee, B., Sara, G., Goldner, E. M., Prince, P. N., Ramanuj, P., et al. (2016). A review of mental health recovery programs in selected industrialized countries. International Journal of Mental Health Systems,10, 73. https://doi.org/10.1186/s13033-016-0104-4.
Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., et al. (2014). Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems. World Psychiatry,13, 12–20. https://doi.org/10.1002/wps.20084.
Tepper, M. C., Cohen, A. M., Progovac, A. M., Ault-Brutus, A., Leff, H. S., Mullin, B., et al. (2017). Mind the gap: Developing an integrated behavioral health home to address health disparities in serious mental illness. Psychiatric Services,68, 1217–1224. https://doi.org/10.1176/appi.ps.201700063.
van Weeghel, J., van Zelst, C., Boertien, D., & Hasson-Ohayon, I. (2019). Conceptualizations, assessments, and implications of personal recovery in mental illness: A scoping review of systematic reviews and meta-analyses. Psychiatric Rehabilitation Journal,42, 169–181. https://doi.org/10.1037/prj0000356.
Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. Lancet Psychiatry,3, 171–178. https://doi.org/10.1016/s2215-0366(15)00505-2.
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry,72, 334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502.
Wang, P. S., Demler, O., & Kessler, R. C. (2002). Adequacy of treatment for serious mental illness in the United States. American Journal of Public Health,92, 92–98. https://doi.org/10.2105/ajph.92.1.92.
Whittington, J. W., Nolan, K., Lewis, N., & Torres, T. (2015). Pursuing the triple aim: The first 7 years. Milbank Quarterly,93, 263–300. https://doi.org/10.1111/1468-0009.12122.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Research Involving Human Subjects/Animals
This article does not contain any research conducted by the authors involving human participants or animals.
Informed Consent
This article did not involve any participants who required informed consent.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kerman, N., Kidd, S.A. The Healthcare Triple Aim in the Recovery Era. Adm Policy Ment Health 47, 492–496 (2020). https://doi.org/10.1007/s10488-019-00997-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-019-00997-0