Priorities in Mental Health Services Research

David Chambers, D.Phil.Chief, Services Research and Clinical Epidemiology Branch

Division of Services and Intervention ResearchNational Institute of Mental Health

June 9, 2008AcademyHealth 2008

NIMH’s Strategic Objectives• Strategic Objective 1: Promote Discovery in the Brain and

Behavioral Sciences to Fuel Research on the Causes of Mental Disorders

• Strategic Objective 2: Chart Mental Illness Trajectories to Determine When, Where, and How to Intervene

• Strategic Objective 3: Develop New and Better Interventions for Mental Disorders that Incorporate the Diverse Needs and Circumstances of People with Mental Illness

• Strategic Objective 4: Strengthen the Public Health Impact of NIMH-Supported Research

A Broader Context for Services Research at NIMH

• Consistent with the Strategic Plan of NIMH• Consistent with the Division of Services

and Interventions Research– Develops research that establishes the

effectiveness of interventions and the optimal access, quality, and outcomes of mental health services

Snapshot of NIMH Services Research

• Key priority areas– Improving access, quality, and outcomes of

care– Economics of mental health care– Reducing Health Disparities– Enhancing capacity for services research– Clinical Epidemiology– Dissemination and Implementation of EBPs

NIMH Services Research Portfolio

• 153 Research Project Grants • 59 Career Development Awards • 12 Research Centers

– 7 Developing– 5 Advanced – 11 Research Programs– CE, CH, DR, DX, EC, HD, MS, PC, QQ, SC,

SQ (across the lifespan, demographics)

NIMH Services Research

• Breadth of Contexts– Schools, Corrections, Child Welfare, Primary

Care, Community MH, Nursing Homes, workplace (current)

– Virtual environments, Anywhere (future)• From Service Use to Service Impact

– Clinical Epidemiology focus on current need, utilization, disparities

– Services ITVs on directly improving MH care

Diverse Staff Expertise• Epidemiology• Social Work• Economics• Psychology• Organizational Behavior

Multi-disciplinary field benefits from multi-disciplinary staffing

SOURCE: http://www.nimh.nih.gov/research-funding/scientific-meetings/recurring-meetings/namhc/reports/road-ahead.pdf

National Advisory Mental Health Council’s Report on Services Research (2006)

NAMHC “Road Ahead” Report• RECOMMENDATION:

NIMH should improve impact of research on policy and facilitate policy research

Encouraging State Policy Research

• Concept derived from availability and lack of integration of administrative data within state systems

• Current contract to NRI – to assess existing data quality for use in research– to develop a database of candidate policies for research– to develop rules, regulations to ensure accessibility of data to

research and privacy rules to ensure data security• Current RFA (MH-09-050), submission date August 7, 2008, to

– Develop studies to identify the impact of state financial, workforce, and other policies on cost, quality of care and patient outcomes.

– Enable states to contribute own data, utilize other data to address specific policy questions of interest

• Long term goal of creating a “natural laboratory” to facilitate cross-state comparative research– NIMH facilitates, and incubates, but does not run

NAMHC “Road Ahead” Report• RECOMMENDATION:

NIMH should help add research components to demonstration projects funded by other agencies and departments (e.g., SAMHSA, SSA, CMS, and other NIH Institutes).

A Course for the Future

• Stage One—Connecting researchers to ongoing efforts

• Stage Two—Aligning research components of existing Demos

• Stage Three—Collaborating on future Demos

• Stage Four—Assessing NIMH research studies as candidate pilots for large demos

NAMHC “Road Ahead” Report

• RECOMMENDATION:

NIMH should increase health information technology research.

How Health Information Technology (HIT) Can Inform

Mental Health Practice

EVIDENCE-BASED PRACTICEEVIDENCE-BASED/

RESEARCH-TESTED/EFFECTIVE PRACTICES

INFORMED CLINICAL DECISION-MAKING

How do we improve the capacity of providers to use research to best deliver care to consumers/patients?

How do we improve the uptake of practices demonstrated to improve consumer/ patient outcomes?

INTEGRATION INTEGRATION

Chambers, 2008

EVIDENCE-BASED PRACTICEEVIDENCE-BASED/

RESEARCH-TESTED/EFFECTIVE PRACTICES

INFORMED CLINICAL DECISION-MAKING

INTEGRATION INTEGRATION

Technology Tech

nolo

gy

•Electronic Health Records

•Decision Support

•E-Training Opps

•Dissem. Tools

•Fidelity Measures

•IT platforms to deliver practices

•Monitoring/Feedback

•IT-assisted Training

Chambers, 2008

HIT: The Way Forward• Develop an agenda for use of HIT to improve

Mental Health care.• Possible workshop to facilitate partnerships

between HIT expertise and MH• Focus on where IT is currently (e.g. social

networking, virtual environments), where it can go in future, not as much on where it’s been (e.g. phone, static websites)

• Change how research is done and what is researched

Services Research as part of the Translational Agenda

Two Kinds of Translation

Bench BedsidePathophysiologyDiagnostic tests

BiomarkersNew treatments

PracticeClinical Trials Networks

Practical trialsServices research

Handoff for dissemination

A Feedback Loop

Bedside Practice

Clinical Trials NetworksPractical trials

Services researchHandoff for dissemination

Clinical EpidemiologyResearch on Clinical Decision-making

Systems ResearchHealth Disparities Research

Quality of Care and Implementation Research

RESEARCH PROGRAMS:1. Child and Adolescent Services Research Program2. Clinical Epidemiology Program3. Disablement and Functioning Research Program4. Dissemination Research Program5. Financing and Managed Care Research Program6. Methodological Research Program7. Outcomes and Quality of Care Program8. Primary Care Research Program9. Disparities in Mental Health Services Research Program10. Socio-cultural Research Program11. Systems Research Program

Description of the Programs is available at:http://www.nimh.nih.gov/about/organization/dsir/

services-research-and-epidemiology-branch/index.shtml

NIMH Services Research Program Staff:David Chambers, D.Phil. – Branch Chief, SRCEB;

Chief, Dissemination and Implementation Research Program (Organizational Behavior)

Denise Juliano-Bult, MSW– Systems Research and Disablement and Functioning Programs (Social Work)

Karen Anderson Oliver, Ph.D.– Outcomes and Quality of Care and Clinical Epidemiology Programs (Epidemiology)

Carmen Moten, Ph.D.—Primary Care, Socio-cultural, and Disparities in MH Services Research Programs (Psychology)

Agnes Rupp, Ph.D.—Financing and Managed Care Research and Research Methods Programs (Economics)