Administration and Policy in Mental Health Vol. 17, No. 4, Summer 1990

SURVEYS AND REPORTS

Ronald W. Manderscheid, Ph.D.

Ronald W. Mandersheid is chief of the Survey and Re- ports Branch, Division of Biometry and Applied Sciences, NIMH. He is involved in the development, implementa- tion, and reporting of national mental health statistical surveys. He also participates in the national evaluation of the Community Support Programs and the McKinney Homeless Demonstrations for the Mentally Ill.

DECISION SUPPORT SYSTEMS

The National Institute of Mental Health (NIMH) recently published the latest standards for the content of mental health decision support information systems. This report, a collaborative endeavor between N I M H and the state mental health agencies, covers data standards for client, human resource, financial, event, and organiza- tional data components. The system proceeds from the point of view that the first and primary use of statistical information is for "decision sup- port" by program and clinical managers. The re- port also includes an analysis of statistical report- ing to auxiliary entities, such as corporate headquarters, the state, or NIMH.

At both the primary and auxiliary levels, a key ingredient of the revised standards is integration across data components, e.g., linkage of client and human resource data through clinical events. Such integrated systems will provide greater power for managerial decisions, because the essential fea-

tures of clinical and financial systems will be in- cluded.

The report will serve as the key document in further implementation of the joint NIMH/State Mental Health Statistics Improvement Program, a continuing effort to improve the quality of mental health statistical information at all levels. Our hats are off to Dr. Walt Leginski, who prepared the report, and to all members of the task force that formulated its content. If you have not yet re- ceived a copy but would like one, please let me know.

MHSIP IMPLEMENTATION GRANTS

At the end of Fiscal Year 1989, NIMH awarded grants to 36 state mental health agencies for the purpose of implementing the new data standards for decision support systems. These grants aver- aged approximately $100,000 per State in direct costs. They represent the first funding ever pro- vided by NIMH to upgrade statistical capacity in the mental health field.

The grants cover a broad range of topics. How- ever, some common themes are evident. Many of the grants will seek to improve the quality of the data collected from community-based mental health programs funded by the state mental health agencies. A number will seek to develop data link- ages between state mental hospitals and commu-

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nity programs in order to be able to follow clients from setting to setting.

Improved quality of state mental health agency data will have benefits for the states, as well as for participating programs. With improved data com- parability, program managers will be able to com- pare their own results with those of other similar programs in the state.

Funds for the grants are part of a set-aside from the Alcohol, Drug Abuse, and Mental Health Ser- vices Block Grant in Fiscal Year 1989. Dr. Lewis Judd, the director of NIM H, and Dr. Alan Lesh- ner, the deputy director, worked closely with rep- resentatives from the state mental health agencies to formulate a plan for the block grant set-aside. In addition to the grants, this plan included a series of announcements to the mental health field solicit- ing research grant applications on services to per- sons with severely disabling mental illness and on the care of persons with dual diagnoses of mental illness and substance abuse, as well as data collec- tion activities described below.

Cecil Wurster, who recently retired as associate director for Program Planning of the Division of Biometry and Applied Sciences, N I M H , is due considerable credit for implementing both the grant initiative and the Mental Health Statistics Improvement Program. The Ad Hoc Advisory Group to the Program, currently headed by Nancy Wilson from the state mental health agency in Colorado, also contributed extensively to this development.

NATIONAL REPORTING PROGRAM

Another resource for managers of mental health programs and systems is the statistical information maintained by the N I M H National Reporting Program. Through this Program, N I M H collects, analyzes, and reports statistical information on all specialized mental health programs in the United States. Current developments are described be- low.

NRP REVIEW GROUP

N I M H is currently sponsoring a review of its statistical data collection activities. The review group, headed by Michael Hogan, commissioner of mental health in Connecticut, is composed of representatives of the state mental health agencies, national mental health organizations, local pro-

viders, advocacy groups, and academic depart- ments. The reviewers have been asked to provide answers to three basic questions: What informa- tion should N I M H be collecting? What mecha- nisms should be used to collect these data? How should the resulting information be disseminated to the mental health field? A final report is antici- pated in 1990.

ORGANIZATIONAL INVENTORY

Under the leadership of Michael Witkin, the N I M H National Reporting Program operates a biennial Inventory of Mental Health Organiza- tions and General Hospital Mental Health Ser- vices. The Inventory is a complete enumeration survey of all specialty mental health organizations and general hospitals with separately organized psychiatric services. Screener information is also obtained on integrated psychiatric service oper- ated by general hospitals. Data items include orga- nizational auspices, types of services offered, num- ber and characteristics of patients served, staffing by discipline, revenues, and expenditures. Patient characteristics and revenues were included for the first time in the 1983 Inventory. In the 1988 In- ventory, coverage has been extended to include community residential organizations for the men- tally ill. In selected years, special topics are ad- dressed, such as forensic services in 1985, electro- convulsive therapy and services to victims of crimes in 1986, and case management services in 1988.

Since 1983, the state mental health agencies have played a progressively stronger role in the collection of data for the Inventory. Several states provide electronic data on state-operated or funded mental health organizations. Other states provide paper-copy data on a subset of these orga- nizations. Most of the remaining states participate in the mailout or receipt of survey forms. In 1983 and 1986, Inventory results served as the basis for production of a report by the National Association of State Mental Health Program Directors, titled State Mental Health Program Indicators. This report provides comparative state data on state-operated and funded mental health organizations.

The N I M H National Reporting Program has also worked closely with other national organiza- tions in implementing the Inventory. This has been accomplished through formal relationships with these organizations. For the 1988 Inventory, the American Hospital Association is serving as subcontractor for the general hospital component of the survey; the National Association of State Mental Health Program Directors, for state and

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county mental hospitals; and the National Asso- ciation of Private Psychiatric Hospitals, for private psychiatric hospitals. These collaborative relation- ships have improved the quality of the survey items included in the Inventory; have prevented duplication of data collections in the field; and have increased the analytical focus of the national organizations.

N I M H is currently completing a contract that has examined the utility of feedback reports from the Inventory. These feedback reports were pro- vided to a sample of local mental health organiza- tions so that they could compare their own results against national statistical norms. Findings showed that most local providers found the reports to be of direct use, with slight variability across topics covered, e.g., staffing, revenues, patient characteristics. Generally, facilities commented fa- vorably upon N I M H efforts in this area. If you would like a copy of the executive summary from the study, please contact me.

From block grant set-aside funds, N I M H has awarded a contract to the National Association of State Mental Health Program Directors Research Institute, Inc., to examine the feasibility of in- creasing the number of state mental health agen- cies that serve as focal points for the collection of Inventory data from state operated or funded pro- grams. Implementation of such a system would reduce reporting burden on local facilities. This same contract will also examine the feasibility of implementing a profile system of quantitative and qualitative indicators for each state mental health agency. This profile system would permit direct interstate comparisons for use in management de- cision-making.

ANNUAL CENSUS OF STATE MENTAL HOSPITALS

The Annual Census provides information on the age, sex, and diagnostic distributions of admis- sions and resident patients in state mental hospital inpatient programs. From the resultant analyses, an annual report is prepared that shows data for the United States and each state. The results serve as the bellwether of deinstitutionalization, and are frequently employed by the Congress, researchers, the media, and others.

CLIENT SURVEYS

Under the leadership of Marilyn Rosenstein, the N I M H National Reporting Program operates

a series of periodic sample client surveys of persons served in specialty mental health organizations. Sample surveys of admissions to inpatient and outpatient programs have been conducted approx- imately every five years, starting in 1970. These surveys were designed to collect information on the sociodemographic, clinical, and service char- acteristics of persons admitted for care.

In 1986, several important improvements were made to the survey program. Separate surveys for each setting were integrated into a single data collection for inpatient and outpatient programs, and partial care programs were added for the first time; coverage was expanded to include not only admissions, but also persons who were discharged and those continuing care; and refinements were made in data collection procedures and statistical estimation methodology. Data from these periodic surveys provide the only national trend informa- tion on specific patient characteristics. They are used extensively for significant policy analyses re- garding the types of persons served.

In between the periodic surveys conducted ap- proximately every five years to update and expand trend data, N I M H also conducts surveys with a more specialized focus to close gaps in our knowl- edge base. In 1988, N I M H conducted a field test for a longitudinal sample client survey of outpa- tient programs. Results have been used to finalize the design for a full-scale national survey sched- uled for 1990. The proposed survey is designed to track cohorts of admissions and persons under care for a one-year period to examine patterns of ser- vice use, providers of care, service costs, recidi- vism, changes in client functioning, and use of other services in the community. This survey will represent the first longitudinal data collection to be undertaken by the N I M H National Reporting Program.

INVENTORY OF STATE ADULT CORRECTIONAL FACILITIES

An Inventory of Mental Health Services in State Adult Correctional Facilities is nearing com- pletion under the direction of Ingrid Goldstrom of the Branch staff. This Inventory is the first effort by N I M H to collect data on mental health services provided in important settings outside the spe- cialty sector. Data items are similar to those of the specialty sector Inventory described above. State prisons were chosen because of the influx of men- tally ill persons into prisons and jails over the past decade.

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PILOT PROJECT ON PATIENT DATA FROM STATE MENTAL HOSPITALS

This is a collaborative undertaking between N I M H and the states to assess the feasibility and benefit of collecting patient-specific data on each episode of care that occurs in state mental hospital inpatient services. Eleven state mental health agencies participated in the first phase of the proj- ect, during which data were collected in electronic form for 1984 to 1987 for all state mental hospitals in these 11 states. These data are a rich resource for relating length of stay and recidivism patterns to sociodemographic and clinical characteristics of patients. Walt Leginski serves as the N I M H lead person for this project.

From block grant set-aside funds, N I M H has awarded a contract to the National Association of State Mental Health Program Directors Research Institute, Inc., to expand the pilot project. The contract will increase the number of states in the project by at least three, add data for 1988 and 1989, and implement a series of research projects by participating states. Each of these research pro-

jects will have implications for management of state mental hospital programs.

SURVEY OF SEVERELY DISABLED MENTALLY ILL PERSONS

A Mental Health Supplement to the 1989 Na- tional Health Interview Survey of the National Center for Health Statistics has been developed to identify persons within the household population of the United States who suffer from severe and disabling mental illness. Questions are being asked about types of disorder, types of disability, recent contacts for care, and participation in So- cial Security Administration disability programs. When linked with the core data from the survey, the supplement will provide estimates of the num- bers and characteristics of severely disabled men- tally ill persons from the household population in the United States.

In this first column, I have tried to set the stage through a summary overview of major current developments in mental health statistics. In future columns, I will provide statistical findings of po- tential interest to you.