Mental Health Treatment & Services Research

1. Mental Health Treatment & Services Research Enola Proctor, MSSW, PhD Briefing for the Congressional Social Work Caucus May 25, 2011

2. Social Workers in Mental Health Care The major service provider to persons with mental illness Provide mental health services in many settings, especially publicly funded Supervise Administer agencies & programs Conduct research on improving care Staunch commitment to under-served groups

3. Social workers Advance Objective 4 in NIMH’s strategic plan: to help close the gap between the development of new research-tested interventions and their widespread use by those most in need

4. Urgent needs for mental health care • Returning veterans • Highest suicide rates on record, anxiety, PTSD, depression • National Guard & Reserves at higher risk with less access to mental health services • Natural disasters • Unemployment • Unemployed people 30% more likely to have mental health problems

5. Mental health care is poor US mental health care: “D grade” (NAMI) Fragmented, dangerous “cracks” in system (President’s New Freedom Commission) Physical healthcare is improving, but no improvement in depression care (AHRQ’s 2010 Health Care Quality Report Mental health system may be worsening

6. Toll of mental disorder: first among disabling illnesses in the U.S. • Poor health: • Cardiac disease • Substance abuse • Social problems • Health expenditures • Mortality: • US suicide rate rising (AHRQ) • Life span shortened by 25 yrs for those with SMI • Reduced productivity & functioning • School & workplace absenteeism, dropout

7. Access gap Persons with: • schizophrenia: 95% get no care/ poor care • bipolar disorder: < half receive any treatment • mental illness +and substance use disorder: 8.5% of receive any treatment for both problems Youth with mental disorder: 1/3 receive services Older adults with depression: most get no care Teens with eating disorders: most get no treatment

8. Racial disparities in care African American children use crisis services or emergency rooms for mental health care (Snowden, 2009) African Americans more likely to receive invasive services African Americans more likely to receive poorer quality care

9. Quality gap: poor quality services We have growing number of effective treatments for mental disorder Many developed through NIMH’s program of intervention research BUT <10% of the U.S. population with a serious mental disorder receives adequate care (Kessler et al, 2005) WHY? We do not know how to best implement and sustain proven treatments in real-world settings of care

10. Research to practice: The Translation gap Research findings are “lost in translation” From discovery to real world care: 17 years for 14% of new discoveries Once discoveries are implemented: • poorly delivered • inequitably delivered • not sustained

11. Research-implementation pipeline* Mittman, 2010 Health Behavior/Promotion Research Clinical Science Clinical Improved Health Processes, Outcomes TranslationalPre-ClinicalResearch Implemen-tationResearch Effective-ness Studies Basic Science Health Behavior Health Services Basic/Lab Science Health Services Research

12. Diner BM, et al. Academic Emergency Medicine 2007; 14: 1008-1014

13. Consequence of implementation gap:Return on investment failure State of art treatments, based on decades of research, are not being transferred to community settings. Poor quality care, disparities continue Suffering, morbidity are prolonged Nation doesn’t benefit from billions of US tax dollars spent on research to develop & test effective care Wasted resources and lost opportunity

14. Research needs: Institute of Medicine Science has developed a strong armamentarium of effective psychosocial therapist and medications” for mental disorder…… “Research is needed to identify how to best meet the needs of children, older adults, individuals who are members of cultural or ethnic minorities, and those with complex an co-occurring” illnesses

15. Pressing research needs • Improving access • Reducing disparities • Delivery of effective care • Strategies for quality monitoring • How to move new discoveries into real world settings • Efficiency • Reducing staff turnover • Training models to ensure best, current care • Sustainability of effective care, once introduced

16. Translational science: turning discovery into improved health NIH priority (program announcement) NIH “blue print,” CTSA programs, Translational research =one of Dr. Collins’ five priorities Can inform moving current, effective treatments into usual settings of care” (IOM)

17. Translational science at NIH Heavier emphasis on discovery than on translation to health care • Emphasis is on drug discovery (T1) • Prevention research <1% of total federal health budget • 10% or less of prevention research focused on dissemination • Health services research = 1.5% of biomedical research funding Current 1.5% spending on health services research “is probably costing lives” * Farquhar, 1996; Woolf, 2008

18. Implementation research: potential Translation research, or IR, can do more to decrease morbidity and mortality than new drugs* Findings can improve care by as much as 67% -250%* We cannot afford the inefficiencies of delivering poor care *Woolf & Johnson, 2005; Woolf, 2008

19. Service systems research: return on investment • Only path to turn basic and clinical research into health benefit • Greater service effectiveness * • Efficiencies in care • Reductions in high cost staff turnover *Glisson et al., 2010

20. Challenging times • For national budget • For nation’s health and mental health • For reaping return of significant investments in basic and clinical research Urge highest possible levels of support for treatment, service system, and implementation research at NIMH

21. contact information: Enola Proctor: ekp@wustl.edu