mental health treatment & services research enola proctor, mssw, phd briefing for the...
TRANSCRIPT
Mental Health Treatment & Services Research
Enola Proctor, MSSW, PhD
Briefing for the Congressional Social Work Caucus May 25, 2011
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
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
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
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
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
Access gap
Persons with: schizophrenia: 95% get no care/ poor care bipolar disorder: < half receive any treatmentmental 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
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
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
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
Research-implementation pipeline* Mittman, 2010
TranslationalPre-ClinicalResearch
Basic Science
Improved Health Processes, Outcomes
Implemen-tationResearch
Clinical
Health Behavior
Basic/Lab Science
Clinical Science
Health Services Research
Health Services
Health Behavior/Promotion Research
Effective-ness Studies
Diner BM, et al. Academic Emergency Medicine 2007; 14:
1008-1014
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
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
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
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)
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 fundingCurrent 1.5% spending on health services research
“is probably costing lives” * Farquhar, 1996; Woolf, 2008
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
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
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
