Closing the Gaps: Reducing Disparities in Mental Health Treatment through Engagement
Meeting Summary: September 12, 2011 – September 13, 2011
Office for Research on Disparities and Global Mental Health (ORDGMH)
Division of Services and Intervention Research (DSIR)
National Institute of Mental Health (NIMH)
In September 2011, the Office for Research on Disparities and Global Mental Health (ORDGMH) in the Office of the Director and the Division of Services and Intervention Research (DSIR) at NIMH convened a workshop, “Closing the Gaps: Reducing Disparities in Mental Health Treatment through Engagement.” This workshop brought together thought leaders from a range of fields—epidemiology, psychology, psychiatry, social work, and community-based services and intervention research—and representatives of key federal agencies to discuss the role of engagement in reducing mental health treatment disparities.
Marked disparities exist in mental health treatment. For example, racial/ethnic minorities with mental disorders consistently have less access to care, receive lower quality service, and have higher attrition rates in treatment. Similarly, those with serious mental illness (SMI) consistently confront barriers to service access and experience diminished continuity and quality of care. Treatment engagement occurs at multiple levels (e.g., systems, community, family, network, individual), and factors affecting it can vary widely across populations. Likewise, treatment engagement definitions, measures, and outcomes vary across studies. In addition, despite a growing evidence base for the effectiveness of treatment engagement interventions, it is unclear how widely those interventions are implemented effectively and consistently in community settings. These issues combine to complicate the articulation of NIMH priorities and goals.
The goals of the workshop were to: 1) identify areas of treatment engagement research where continued investment is needed; 2) identify evidence-based interventions with the greatest promise for implementation and scale-up across diverse populations; 3) identify barriers to implementation and scale up of evidence-based interventions; and 4) chart a course to maximize public health impact through key collaborations and partnerships. Day one of the workshop provided an overview of the current state of measurement, outcomes, and evidence-based interventions across diagnoses and populations. Day two of the workshop featured presentations and discussion of the state-of-the-science regarding consumer priorities, community factors in engagement, implementation strategies, and exemplary interventions for special populations (e.g., people living with depression, people living with SMI, racial/ethnic minorities, children and adolescents, and older adults). A final session synthesized the workshop’s emergent themes, and the ensuing discussion addressed the areas of greatest need and how the Institute might shape its research priorities to address that need.
The workshop framed several potential research questions to address knowledge gaps:
- What are the current availability, distribution, and use of evidence-based engagement strategies in real-world settings?
- What impact do engagement strategies have in real-world settings: in which kinds of settings and with which kinds of clients and providers?
- What are the barriers, facilitators, and challenges to implementing evidence-based engagement strategies among underserved populations?