Program Evaluation and Resource Center, Veterans Health Administration (VHA) Office of Mental Health and Suicide Prevention, Menlo Park, California (Boden, Trafton); Center for Innovation to Implementation, VHA Palo Alto Health Care System, Palo Alto, California (Boden); Department of Psychiatry and Behavioral Sciences, Stanford University Medical School, Stanford, California (Trafton); VHA Office of Mental Health and Suicide Prevention, Washington, D.C. (Smith, Klocek).
Psychiatr Serv. 2019 Mar 1;70(3):168-175. doi: 10.1176/appi.ps.201800229. Epub 2018 Nov 30.
Mental health treatment access and quality are influenced by the interplay of structural, organizational, and performance factors-including the number of mental health staff providing direct clinical care relative to patients treated (i.e., staffing ratio), mental health staff productivity, and wait times for scheduled mental health appointments. With no industry standards to follow, the Veterans Health Administration (VHA) developed an outpatient mental health staffing model and a recommended minimum total staffing ratio.
At the level of VHA health care facility (N=140), we conducted cross-sectional regression analyses to examine the relative importance of outpatient mental health staffing and productivity and mental health patient wait times in predicting measures of mental health treatment access and quality.
Outpatient mental health staffing ratios (especially total and therapist staffing ratios) had substantial, positive relationships with overall mental health treatment access and quality, broadly and in specific domains. Staffing ratios generally had stronger relationships with treatment access and quality than did staff productivity and patient wait times.
Mental health staffing ratios should be a primary consideration when trying to improve mental health treatment access and quality at the facility level. Having more mental health staff of all types is associated with better overall access to and quality of mental health services, and multiple staff types are needed to provide high-quality mental health care. Knowledge gained may guide efforts to address challenges in improving access to and quality of mental health services within and outside of VHA.
心理健康治疗的可及性和质量受到结构、组织和绩效因素的相互作用的影响，包括提供直接临床护理的心理健康工作人员数量与接受治疗的患者数量之比（即人员配备比例）、心理健康工作人员的生产力以及预约心理健康预约的等待时间。由于没有行业标准可循，退伍军人健康管理局 (VHA) 开发了一种门诊心理健康人员配备模型和建议的最低总人员配备比例。
在 VHA 医疗保健设施一级（N=140），我们进行了横断面回归分析，以检验门诊心理健康人员配备和生产力以及心理健康患者等待时间在预测心理健康治疗可及性和质量方面的相对重要性。
门诊心理健康人员配备比例（特别是总人员和治疗师人员配备比例）与整体心理健康治疗可及性和质量呈显著正相关，广泛且在特定领域均如此。人员配备比例与治疗的可及性和质量的关系通常比工作人员的生产力和患者的等待时间更为密切。
在尝试提高设施层面的心理健康治疗可及性和质量时，人员配备比例应是首要考虑因素。拥有更多各类心理健康工作人员与更好的整体获得心理健康服务的机会和质量相关，并且需要多种工作人员类型来提供高质量的心理健康护理。所获得的知识可能有助于指导努力解决在 VHA 内外改善心理健康服务的可及性和质量的挑战。
