12 Sep 2016
by Carolyn Graybeal
A record number of attendees gathered in Bethesda, Maryland, August 1-2 for the 23rd NIMH Conference on Mental Health Services Research. The conference theme was “Harnessing Science to Strengthen the Public Health Impact.” Over the course of two days, more than 700 health services researchers, advocacy representatives, and clinicians listened in person or via webcast as 90 researchers presented on topics ranging from citywide healthcare initiatives and technology-facilitated outreach to insurance analysis. Across these different topics several key strategies kept cropping up: the need for stakeholder coordination and communication, the utility of technology-based care, and the need for community involvement.
The Philadelphia Department of Behavioral Health and Intellectual disAbility Services Commissioner Arthur Evans Jr. gave the first day's keynote address, titled “From Black Box to Population Health: Implications for Services Research.” He critiqued the prevailing approach to treatment in which the person is identified as having a problem, processed through the treatment “black box” and then released. “The major problem of this model is that it constrains how we think about how we help people,” he said. “People will say, ‘We need more treatment.’ I believe we need more treatment, but I think we need a lot of other things if we are really going to help people.”
As a case study, he discussed policy changes in Philadelphia that make population health the goal and where traditional treatment practices are just one spoke in the healthcare system wheel. Evans stressed that healthcare services should go beyond the pharmaceutical approach. Health-promoting interventions need to be provided in both treatment and non-treatment settings, and service providers need to work within the community so that care can be delivered as early as possible.
Evans' department helps coordinate comprehensive in-person community screening events that assess somatic, psychological, and social needs. In particular, his department has been working with other agencies to address the need for housing. While housing might not seem like a mental health service, securing housing provides stability for people, helping them recover. He also called for increased funding to support service research to gather community-based data. “Each community has different resources or obstacles to achieve mental health and well-being,” he reminded the audience.
NIMH Services Research and Clinical Epidemiology Branch chief Michael Freed was very positive about the broad-scale strategies Evans discussed. “Providing people’s needs will have a cascading effect in other areas,” said Freed. “Going out and asking what they need, and it [might not] necessarily be mental health, but might be paying rent or taking care of their kids. To address multiple things, … requires strong partnerships with agencies on the ground. Developing these partnerships isn’t necessarily research, but it is necessary groundwork to collect data, to do research, to figure out what works and what does not.”
In a paper session, Rohini Pahwa from New York University continued the community focused theme. Pahwa shared early research examining psychological community integration in people with severe mental illness (SMI). Her research challenges the prevailing notion that people with SMI should be considered recovered or recovering when they spend less time with SMI peers and providers. Her comparison of minority groups with and without SMI suggests that uprooting people with SMI from these peer and provider subgroups may do more harm than good. Such people derive considerable support from these mental health-based networks, which help them integrate into the “healthy” community. Pahwa suggested that service providers need to consider the different dimensions of community integration and how these various community subgroups might affect each other.
In the afternoon, the focus turned to technology in a plenary titled “Harnessing Technology to Optimize Mental Health Care.” Lisa Dixon of Columbia University Medical Center in New York City opened the session with a broad overview of how technology facilitates communication and intervention fidelity at the patient, provider, and community levels. Examples included telehealth, such as the rural first-episode psychosis (FEP) program, online cognitive behavioral training, and CommonGround. She closed with a few “on the ground” lessons such as the importance of establishing partnerships across areas of expertise, investment of both time and money, critical evaluation of the efficacy of the implemented technology, and the fast-paced transformation of technology. “What is possible technologically changes so fast that you think you’ve got it, and then you turn around and everything you are doing is old,” said Dixon. “Partnering with industry can keep us moving fast.”
Jeff Olivet from the Center for Social Innovation (C4) in Needham, Massachusetts, took the audience in depth with a review of research from his group examining the efficacy of online training for the behavioral health workforce. C4 teamed with service research experts to design a dynamic combination of simulations and live online training sessions based on evidence-based practices. The training program enables trainees to connect with research experts and peers in the field, and is driven by what trainees need as opposed to simply providing them information.
Comparisons between onsite trainees and online trainees showed equal levels of knowledge gain and workforce implementation. However, online trainees reported higher knowledge retention nine months out, making a strong case for a training program which is a third the cost of onsite training and easily scalable. C4 will be launching a new project funded by NIMH to examine how to expedite the dissemination of best practices for FEP coordinated specialty care. The project is based on findings from the Recovery After an Initial Schizophrenia Episode (RAISE) studies (see SRF news story) and combines research on online learning strategies.
Olivet also showcased a bit of his collaboration with Dixon and the OnTrackNY program. Currently, OnTrackNY is exploring ways to target young people with FEP through a role-playing game that educates teens on how to cope with their symptoms in family, work, and school settings in a personalized way. A big hit with test groups was the “movie theater” feature in which people in recovery share their stories. While research is only in Phase 1, early data showed improvements in self-impression of recovery and hope indices in test groups.
Finally, Danielle Schlosser of the University of California, San Francisco, made the case that traditional brick-and-mortar healthcare delivery is not enough for―or even desired by―at-risk people. Instead, online and mobile access seem to be preferred, particularly by young people. She shared a few statistics. Of the people who completed Mental Health America’s free online psychosis screening, 95 percent scored as at-risk. Of this group, only a quarter wanted face-to-face care, while half would accept an online system to manage symptoms. Users of the crisis text hotline 741741 are primarily young people, a third of whom express depressive or suicidal thoughts.
In her own research into mobile platforms, Schlosser found that clients do not want to be defined by their illness, and they seek to live normal lives yet find comfort in connecting with peers. In designing the mobile platform PRIME (Personalized Real-time Intervention for Motivational Enhancement), she said, “We decided we did not need to lead with illness, and instead [we wanted to] inspire changes to improve quality of life through a tone of happiness.” Results from preliminary trials show that 65 percent of users who engaged with the platform were self-referred, and there was 93 percent retention. “It is a really exciting time where we can partner with technology leaders to really transform care in this country and around the world,” said Schlosser.