Post by Former NIMH Director Thomas Insel: From Research to Practice
Conventional wisdom says that there is a long delay between a research finding and putting that finding into practice. Based on treatments for hypertension, that delay is usually described as 17 years. So it is especially worth noting an announcement last week from the Substance Abuse and Mental Health Services Administration (SAMHSA) that 5 percent of the Mental Health Block Grant allocation would be used to implement evidence-based treatments for first episode psychosis (FEP). The overall approach – team-based, youth-oriented specialty care –was developed in consultation with the National Institute of Mental Health (NIMH), and is based on similar programs operating in Australia and Europe, as well as lessons learned in the Recovery After an Initial Schizophrenia Episode (RAISE) project. While part of the RAISE study is ongoing, completed studies in New York and Maryland have already demonstrated the feasibility of implementing this complex approach in community settings in the United States. Rather than a 17-year delay, the feasibility component of the RAISE project was completed in December, 2013, and is now being implemented by SAMHSA about 17 weeks later – a vast improvement in the timeline for moving research into real-world settings where it can truly have the broadest impact.
How did this happen so quickly? SAMHSA provides states funding via the Mental Health Block Grant to support local mental health programs. In this year’s budget, Congress directed SAMHSA to require that states set aside 5 percent of the Block Grant funds to support “evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders.” With recent experience demonstrating the feasibility of creating FEP treatment programs in U.S. community treatment settings NIMH staff developed an overview document for state planners and providers, Evidence-Based Treatments for First Episode Psychosis: Components of Coordinated Specialty Care (CSC), as well as a resources page that includes a variety of CSC program development materials, such as treatment manuals, videos, educational handouts, and worksheets. Like the interventions tested in the RAISE studies, CSC is based on collaborative treatment planning, a respectful and effective means for establishing a positive therapeutic alliance, and maintaining engagement with individuals and their family members over time.
To prepare states for the implementation of the set-aside, SAMHSA and NIMH are co-hosting national webinars to inform states of the evidence-based components of coordinated specialty care for FEP. In addition, SAMHSA will be providing technical assistance and resources to states as they develop and implement their plan. Some states already have significant investments to help individuals experiencing FEP. We encourage these states to coordinate existing programs with programs supported by the new 5 percent set-aside. We hope that, with this new Block Grant investment, leveraged by services reimbursed by Medicaid or private insurance, every state should be able to begin to develop or enhance early intervention services for FEP.
While SAMHSA’s mission is service and NIMH’s is research, we share the same goal of recovery for those experiencing a first episode of psychosis. Rather than a 17-year delay, this new announcement from SAMHSA uses the latest evidence to implement a much-needed innovation over the next few months across the country. This is a great example of what can happen when two agencies work together, moving research into practice to ensure the best outcomes.
This blog is also posted on SAMHSA’s Blog.