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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

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

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

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 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* 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: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

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
  • 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 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

implementation research potential
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
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
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