Feature

Every year, the knowledge base of therapies that help people cope with, and even recover from, serious mental illness grows. But adopting these therapies takes time.

Federal mental health officials and psychologists discussed ways to reduce this "science to service" gap at a session sponsored by Committee for the Advancement of Professional Practice (CAPP) at APA's 2006 Annual Convention. The program also focused attention on a major challenge for the health service delivery system: getting mental health treatment to the individuals who need it.

Federal officials said they're working to get more information about evidence-based programs and practices into the hands of practitioners through Web sites and information kits. For example, A. Kathryn Power, director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration (SAMHSA), said her office is distributing kits that detail evidence-based practices for people being treated for serious mental illness at public mental health clinics. Another planned set will address helping older adults who struggle with depression after developing chronic health problems, Power said.

All of the kits will contain information about training resources and help practitioners decide if a given approach is applicable for their clients, she said.

"People can recover from serious mental illness, and people do recover, but their recovery often hinges on access to services that best meet their needs," she said.

Kevin Hennessy, PhD, senior director of SAMHSA's Science to Service Initiative, said other initiatives to bring more information about evidence-based programs to the public and providers later this year and in 2007 include the:

  • National Registry of Evidence-Based Programs and Practices-a voluntary rating and classification system providing the public with information on the scientific basis and practicality of mental health and substance abuse treatment programs.

  • Effectiveness Library-a database of reviews assessing the evidence for interventions preventing substance abuse, promoting mental health and treating mental and addictive disorders.

  • The Pocket Guide-a Web listing of evidence-based substance abuse and mental health interventions.

  • Substance Abuse and Mental Health Implementation (SAMHI) awards-awards spotlighting community-based organizations that have successfully implemented one or more evidence-based services to help consumers.

Another of the speakers, Geoffrey Reed, PhD, former assistant executive director for professional development in the APA Practice Directorate, said that when it comes to mental health care, applying evidence-based practice is a process that should be guided by clinical expertise related to applying research findings along with other information relevant to individual clinical situations. Defining evidence-based practice as the mechanistic implementation of manualized treatments is problematic, he said.

Research shows that the onset of mental health disorders typically occurs in adolescence, and that the average delay in starting treatment stretches anywhere from five to 23 years, depending on the disorder. Only one-third of those with mental health disorders receive adequate treatment, and many receive no treatment at all. The costs and consequences of mental health disorders are cumulative across the lifespan and make them among the highest sources of global disease burden. Yet mental health treatment remains vulnerable to cost-cutting, Reed said.

Reed said discussion of evidence-based treatment should not be used as a justification for restricting access to mental health services known to be generally effective. Rather, the priority should be making mental health treatment more accessible, less stigmatized, open to patient choice, and above all, available and affordable to the broadest range of people. "Impact is a product of effect size and penetration," said Reed. "You can have a really effective treatment, but if nobody wants it and nobody uses it, it doesn't have an impact on the population."

Steve Silverstein, PhD, a member of CAPP's Task Force on Serious Mental Illness and Serious Emotional Disturbance, described an evolving document called the Training Grid (PDF, 534Kb), which is further explained in the December 2005 Monitor. Developed by task force members, the grid is a compilation of training material for practitioners on the "best practices" known to improve the quality of life and outcomes for people with serious mental illness.

Will Spaulding, PhD, the current task force chair, shared additional information about the task force's role and ongoing work to promote evidence-based practice for the treatment of serious mental illness and serious emotional disturbance.