Administration and Policy in Mental Health Vol, 19, No. 5, May 1992

STATISTICAL RESEARCH ACTIVITIES i

DEVELOPMENTS IN MENTAL HEALTH STATISTICS RESEARCH

Ronald W. Manderscheid, Ph.D.

Many exciting developments are occurring in mental health statistics. Most have direct implications for system and program man- agement. Brief glimpses are provided below to give the nature and breadth of these activ- ities..

PATTERNS OF DISORDER AND TREATMENT

Colleagues Dr. Darrel Regier, Dr. Bill Narrow, Mr. Ben Locke, Mr. Don Rae, and I have completed a series of three manu- scripts from the Epidemiological Catchment Area (ECA) study that provide, for the first time, annual prevalence and incidence rates for different mental disorders in the United States; annual national patterns and vol- umes of service use for all mental service delivery settings-specialty, health, human services, and informal--by type of disorder; and a comparison of service delivery data from this study with parallel data from the National Reporting Program for Mental Health Statistics. Readers should find these analyses to be of considerable use because they present a comprehensive picture of

mental disorders and treatment in the United States. Services data from the ECA are presented for the first time.

IMPROVED INFORMATION ON MENTAL HEALTH ORGANIZATIONS

The National Reporting Program for Mental Health Statistics has awarded a con- tract to Social and Scientific Systems, Inc., to conduct the 1992 Inventory of Mental Health Organizations and General Hospital Mental Health Services. For the first time, a significant portion of this Inventory will be carried out by the National Association of State Mental Health Program Directors (NASMHPD) Research Institute, Inc., using the new Organization Information System (OIS) currently being field tested. The OIS represents a new approach to data collection in which state-operated and -funded mental health organizations will re- port information electronically to the state mental health agencies, which, in turn, will provide electronic versions of the data to the Research Institute. This new approach will capitalize on modern microcomputer tech-

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374 Administration and Policy in Mental Health

nology to speed data collection and process- ing, while providing a large-scale data base to the NASMHPD Research Institute and the National Reporting Program.

Other key actors in the 1992 Inventory will be the National Association of Private Psychiatric Hospitals (NAPPH), which will collect information on member private psy- chiatric hospitals, and the American Hospi- tal Association (AHA), which will collect data on general hospital psychiatric services.

An estimated 6,000 specialty mental health organizations, with 14,000 compo- nents, will be included in the Inventory. Data collection will start in the fall of 1992. For this project, Mr. Michael Witkin, the Government Project Officer from our staff, will be joined by Dr. Maure Hurt (Social and Scientific System, Inc.); Dr. Noel Mazade, Mr. Cecil Wurster, and Mr. Ted Lutterman (NASMHPD Research Institute, Inc.); Mr. Ed Kelly (NAPPH); and Ms. Rhonda Goldstein and Mr. Peter Kralovec (AHA).

STATE PROFILE SYSTEM

A full scale field test of a State Profile Sys- tem for state mental health agencies went into the field in late 1991. This system, being de- veloped by the NASMHPD Research Insti- tute, Inc., under contract from the National Reporting Program, will generate a series of quantitative and qualitative indicators that reflect the structure, operations, procedures, human resources, clientele, and financing of the state mental health agencies. Results will be of direct use to the state agencies for man- agement applications and to the research community in order to provide contextual variables to understand clinical and service delivery processes. I serve as the Government Project Officer. Dr. Noel Mazade, Mr. Cecil Wurster, and Mr. Ted Lutterman of the NA- SMHPD Research Institute, Inc., with con- sultation from Dr. Trevor Hadley of the Uni- versity of Pennsylvania, are developing the State Profile System.

LONGITUDINAL PATIENT DATA FROM STATE MENTAL HOSPITALS

Twenty state mental health agencies are accumulating and sharing electronic statisti- cal information on all episodes of care in the inpatient programs of their state and county mental hospitals. The data base, which cur- rently covers the period 1984 to 1989, will make possible the analysis of patterns of care in the hospitals. Under a contract from NIMH, development work on the project is being carried out by the NASMHPD Re- search Institute, Inc., and a subcontract to the Policy Modeling Workgroup of the Wharton School at the University of Penn- sylvania. Dr. Walt Leginski serves as the Government Project Officer. Dr. Noel Mazade, Mr. Cecil Wurster, and Mr. Ted Lutterman represent the NASMHPD Re- search Institute, Inc., and Dr. Arie Shinnar and Dr. Aileen Rothbard represent the Pol- icy Modeling Workgroup.

A recent meeting of participating states was held in Crystal City, VA, to outline research projects to be conducted from the data base that will be of use in managing the state and county mental hospital system. These projects will focus on the size and composition of the hospital population, with particular attention to special populations, such as heavy users; analysis of longitudinal patterns of inpatient and community tenure for different patient groups; and optimiza- tion of hospital bed size.

LONGITUDINAL SURVEY OF CLIENTS IN OUTPATIENT PROGRAMS

Data collection is nearing completion on the first prospective longitudinal survey of clients to be undertaken by the National Re- porting Program. Samples of admissions and persons under care in outpatient mental health programs are being followed for up to one year to examine service use, cost, and level of functioning.

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Feedback reports have been mailed to all participating organizations, based on initial cross-sectional data, so that these organiza- tions can compare the characteristics of their own clients with those of the entire sample of clients from that organization type. Many organizations indicated that these reports were useful. A second round of reports is planned once longitudinal data have been collected. Ms. Marilyn Rosenstein serves as the Government Project Officer for this sur- vey. Social and Scientific Systems, Inc., the contractor doing the field work, is repre- sented by Dr. Maure Hurt and Ms. Colleen Frost.

MHSIP IMPLEMENTATION GRANTS

Grants to 41 of the state mental health agencies have been awarded to implement the data standards of the Mental Health Sta- tistics Improvement Program (MHSIP). Of the 41 awards, 36 states are currently in their third grant year; and five, in their second year. Fourteen states and territories have not yet received implementation grants.

Grantees are implementing the data stan- dards for organizations, clients, human re- sources, and revenues and expenditures, to- gether with those for clinical events. The latter provide a basis for linking all five data sets in a hierarchial configuration. Most states with grants appear to be making good prog- ress in implementing these data standards.

Of particular note, regional user groups have been formed among the states in the northeast, midwest, south, and west to pro- vide a mechanism for discussion of issues and state-to-state technical assistance. Now entering their third year of operation, these regional user groups have proven to be very popular with the states, as well as extremely useful in fostering collaborative effort around common concerns. Each group meets twice a year.

Drs. Ken Lutterman and Agnes Rupp serve as Government Project Officers for the northeast; Dr. Walt Leginski, for the south;

and Dr. Citle Kennedy, for the west. I serve this function for the midwest.

NAPPH ASSESSING FEASIBILITY OF MHSIP STANDARDS

With technical assistance funds from N I M H , the National Association of Private Psychiatric Hospitals (NAPPH) is assessing the feasibility of implementing the M H S I P data standards in three member hospitals. Each of these hospitals will compare M H S I P standards with current practices; implement the M H S I P standards; and assess the cost and difficulty of the conversion. Results will be used to document how NAPPH can im- plement the standards for the entire mem- bership. Mr. Bob Thomas, Executive Direc- tor of NAPPH, and Mr. Ed Kelly, Director of Government Relations for NAPPH, are responsible for the project. Dr. Jonas Waizer, private consultant from New York, is providing technical assistance to the three test hospitals.

MIDWEST GROUP TO DEVELOP PERFORMANCE INDICATORS FOR PUBLIC LAW 99-660 REQUIREMENTS

The M H S I P Midwest User Group will convene a meeting in the spring of 1992 to identify a key set of performance indicators that can be derived from the M H S I P data standards to measure planning requirements of Public Law 99-660 for severely mentally ill populations. Once identified, the mid- western states will field test the indicators as part of Fiscal Year 1992 reporting under the law.

Mr. James Maedke of Illinois prepared the request for technical assistance funds from N I M H to convene the meeting. The State of Indiana mental health agency will host the meeting in Indianapolis during March 1992. Representatives of planning and statistical units for all midwestern state mental health agencies will attend.

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SOUTHERN REGIONAL CONFERENCE ON MENTAL HEALTH STATISTICS

The 1991 Southern Regional Conference on Mental Health Statistics was held in New Orleans, October 27-30, 1991. The theme focused on system change-from developing the vision, through planning and implemen- tation, to assessment and feedback-in an uncertain environment. Ms. Deb Westvold of Iowa is the current President of the Con- ference; Dr. Randy Lemoine of Louisiana is the President-Elect. As a special feature in 1991, the northeastern, southern, and mid- western MHSIP regional users groups held semiannual meetings in conjunction with the Conference.

PAL FELLOWS PROGRAM

In October 1991 the ten Public-Academic Liaison (PAL) Services Research Fellows

met in Washington, D.C., to become ac- quainted with the research of each other and to explore the data and research resources of NIMH. These fellows are generally em- ployees of state mental health agencies who wish to improve their research skills through an academic placement. Each fellow has both a sponsor in the originating agency and a mentor in an academic setting.

NIMH awarded a grant to the NA- SMHPD Research Institute, Inc., to imple- ment this program. Dr. Noel Mazade of the Research Institute and Dr. Howard Gold- man of the Department of Psychiatry at the University of Maryland are Co-Directors.

MARK YOUR CALENDAR

Please note that the 1992 National Confer- ence on Mental Health Statistics will be held at the Mayflower Hotel in Washington, DC, June 2-5, 1992. Please plan to attend.