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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

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Mental health treatment services research

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
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


Administer agencies & programs

Conduct research on improving care

Staunch commitment to under-served groups

Social workers
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
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
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
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
Access gap the U.S.

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

  • Racial disparities in care
    Racial disparities in care the U.S.

    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
    Quality gap: poor quality services the U.S.

    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 to practice: the U.S.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
    Research-implementation pipeline the U.S.* Mittman, 2010

    Health Behavior/Promotion Research

    Clinical Science


    Improved Health Processes, Outcomes



    Effective-ness Studies

    Basic Science

    Health Behavior

    Health Services

    Basic/Lab Science

    Health Services Research

    Consequence of implementation gap return on investment failure
    Consequence of implementation gap: the U.S.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
    Research needs: Institute of Medicine the U.S.

    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
    Pressing research needs the U.S.

    • 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
    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
    Translational healthscience 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

    Implementation research potential
    Implementation research: potential health

    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
    Service systems research: return on investment health

    • 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
    Challenging times health

    • 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