WASHINGTON - A considerable gap exists in mental health and substance abuse treatments known as psychosocial interventions between what is known to be effective and those interventions that are commonly delivered, says a new report from the National Academies of Sciences, Engineering, and Medicine.
Mental health and substance use disorders are a serious public health problem, affect approximately 20 percent of the U.S. population, and often occur together. Psychosocial interventions -- such as psychotherapies, community-based treatments, vocational rehabilitation, peer support services, and integrated care interventions -- aim to improve the health and well-being of those diagnosed with these disorders and are provided in a variety of settings and formats, including individual, family, or group. The new report presents a framework for implementing evidence-based psychosocial interventions, with the ultimate goal of improving outcomes for individuals suffering from mental health and substance use disorders.
"A wide variety of psychosocial interventions play a major role in the treatment of mental health and substance use disorders, but most consumers of mental health care find it difficult to know whether they are receiving high-quality care," said Mary Jane England, chair of the committee that carried out the study and wrote the report, and a clinical professor at the school of public health at Boston University. "The efficacy of a broad range of psychosocial interventions has been established through hundreds of randomized controlled clinical trials and numerous meta-analyses. However, for many patients, the quality of care that is actually delivered is less than ideal."
Psychosocial interventions that have been demonstrated to be effective in research settings are not used routinely in clinical practice or taught in educational programs that train mental health professionals, the committee found. This gap between what is known to be effective and the care actually delivered is due to problems of access, insurance coverage, and fragmentation of care -- which include different systems of providers, separation of primary and specialty care, and different entities sponsoring and paying for care.
The committee recommended that psychosocial interventions be elevated to equal regard as physical health care, measurement and improvement strategies used in mental health care be equated with those used in physical health care, and greater emphasis be given to context and infrastructure for high-quality psychosocial interventions.
Furthermore, the U.S. Department of Health and Human Services should adopt the committee's framework to support policy, research, and implementation strategies designed to promote the use of evidence-based psychosocial interventions. Steps in this iterative process framework are: strengthen the evidence base for interventions, identify key elements of effective interventions, conduct systematic reviews to inform clinical guidelines, develop quality measures to track the outcomes and effectiveness of interventions, and implement quality.
"There is a need to improve the outcomes of psychosocial interventions, given that about one in five people in the U.S. suffers from mental health and substance use disorders," said Victor Dzau, president of the National Academy of Medicine (formerly the Institute of Medicine). "Our committee's report provides an important framework to help fully realize the consistent use of high-quality, evidence-based psychosocial interventions in everyday care."
The study was sponsored by the American Psychiatric Association, American Psychological Association, Association for Behavioral Health and Wellness, National Association of Social Workers, National Institutes of Health, Substance Abuse and Mental Health Services Administration, Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services, and U.S. Department of Veterans Affairs.
The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. The Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. A committee roster follows.
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Pre-publication copies of Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards are available from the National Academies Press on the Internet at http://www.
NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE
Institute of Medicine
Board on Health Science Policy
Committee on Developing Evidence-Based Standards for
Psychosocial Interventions for Mental Disorders
Mary Jane England, M.D. (chair)
Professor of Health Policy and Management
School of Public Health
Susan M. Adams, Ph.D., RN, PMHNP, FAANP
Professor of Nursing, and
Psychiatric Mental Health Nurse Practitioner Program
Vanderbilt University School of Nursing
Patricia A. Areán, Ph.D.
Director of Targeted Treatment Development
Department of Psychiatry and Behavioral Sciences
University of Washington
John S. Brekke, Ph.D.
Frances G Larson Professor of Social Work Research
School of Social Work
University of Southern California
Michelle G. Craske, Ph.D.
Professor of Psychology, Psychiatry, and Behavioral Sciences, and
Anxiety Disorders Research Center
University of California
Kermit A. Crawford, Ph.D.
Division of Psychiatry
Boston University Medical Center, and
Center for Multicultural Mental Health
Frank V. deGruy III, M.D., MSFM
Woodward-Chisholm Professor and Chair
Department of Family Medicine
University of Colorado School of Medicine
Jonathan Delman, Ph.D., J.D., M.P.H.
Assistant Research Professor of Psychiatry
Systems and Psychosocial Advances Research Center (SPARC)
University of Massachusetts Medical School, and
Technical Assistance Center
Constance M. Horgan, Sc.D.
Heller School for Social Policy and Management, and
Institute for Behavioral Health
Haiden A. Huskamp, Ph.D.
Department of Health Care Policy
Harvard Medical School
Harold A. Pincus, M.D.
Professor and Vice Chair
Department of Psychiatry
Columbia University College of Physicians and Surgeons,
Director of Quality and Outcomes Research
New York Presbyterian Hospital,
Irving Institute for Clinical and Translational Research, and
New York City
Enola K. Proctor, Ph.D.
Shanti K. Khinduka Distinguished Professor, and
Center for Mental Health Services Research
George Warren Brown School of Social Work
Rhonda Robinson Beale, M.D.
SVP and CMO
Blue Cross of Idaho
Sarah Hudson Scholle, Dr.P.H., M.P.H.
Vice President for Research and Analysis
National Committee for Quality Assurance
John T. Walkup, M.D.
Professor of Psychiatry,
DeWitt Wallace Senior Scholar,
Vice Chair of Psychiatry, and
Division of Child and Adolescent Psychiatry
Weill Cornell Medical College
New York City
Myrna M. Weissman, Ph.D.
Diane Goldman Kemper Professor of Epidemiology in Psychiatry
College of Physicians and Surgeons and the Mailman School of Public Health
Columbia University, and
Chief, Division of Epidemiology
New York State Psychiatric Institute
New York City
Adrienne Stith Butler