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LINKING RESEARCH AND PRACTICE

April 1, 2007
by DAVID SHERN, PHD
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By working together, we can make real improvements in treatment delivery

The past 20 years have brought important advances in our science base regarding the prevention, treatment, and rehabilitation of mental health and substance abuse disorders, much of which was summarized in the 1999 Surgeon General's report on mental health. For example, depression, once a taboo subject, is now better understood, accepted, and more effectively treated than ever before, with successful treatment rates around 80%.

However, as with all areas of medical care, major gaps exist between our knowledge base and what happens in ordinary practice. A well-known report in 2004 indicated that persons receive medical care that comports with treatment recommendations only about half of the time.1 Closing the gap between clinic-based knowledge and practice is one of the major challenges confronting our field.

In an attempt to address these issues and make services more effective, Mental Health America (formerly the National Mental Health Association) has formed a partnership with the Academic Behavioral Health Consortium to strengthen linkages between academia and the field.

Mental Health America is the oldest public education and advocacy voice for mental health in the country. With more than 320 affiliates, Mental Health America provides a nationwide network of talented and committed staff and volunteers who can assist in the processes of improving care. The Consortium is a nationwide group of mental healthcare researchers and service providers representing 19 of America's leading medical schools. The Consortium represents clinical directors from each of these programs involved both with care delivery and the training of mental health professionals from all of the core disciplines. We formally launched our collaboration by cosponsoring a mental health practice and policy conference in Baltimore on October 27 and 28, 2006.

The blueprint for this partnership is Crossing the Quality Chasm: A New Health System for the 21st Century, the pivotal 2001 Institute of Medicine report that articulated the overarching principles of effective healthcare and provided recommendations for realizing them. Among its principles of effective healthcare are the following, which are central to our mission:

  • Science-based. Services must be based on scientific knowledge.

  • Patient-centered. Care must be respectful and responsive to individual patient preferences, needs, and values, and must include patient values in clinical decision making.

  • Equitable. Care must not vary in quality due to personal characteristics such as gender, ethnicity, geographic location, or socioeconomic status.

Realizing these principles means accelerating the integration of the science base into practice and policy. To accomplish this, researchers must take into account provider and consumer perspectives and preferences. Information support technologies must be designed to assist clinical decision making and to document these decisions and their outcomes. Given the legitimate concerns with cost containment in healthcare, improving the efficiency of care by enhancing its effectiveness must be the preferred strategy. Promoting increased access to and use of quality and culturally appropriate care must remain a central goal.

It also means informing lab-based research with the real-world experience of the clinic or community-based program. While such research is invaluable to providers' understanding of the efficacy of treatments and in establishing best practices, it must be combined with a provider's unique relationship and understanding of the patient. This combination of research, clinical knowledge, and patient preferences results in more effective, patient-centered healthcare.

Our current systems for bringing new information into practice is an area cited by the Quality Chasm report as requiring vast improvements. Mental Health America and the Consortium seek to develop responsive information systems that support best practices by providing a structure for clinical decision making, while leaving the ultimate treatment choices with caregivers and their clients. Making information technologies more accessible and more flexible, says the report, involves:

  • enhancing measurement and improvement infrastructure;

  • improving linkages across systems of care; and

  • participating in the national health information system.

Workforce development is the final component in incorporating knowledge into practice. This means reinventing inservice and preservice training to create the foundation for ongoing quality improvement throughout a professional's career. Mental Health America's partnership with the Consortium and others will help stimulate and support improvement in the effectiveness of our care delivery systems to promote early identification and prevention of mental and addictive disorders.

Much work remains in this tremendous undertaking. Yet I believe it will take us into a new era—one that improves the lives of all people with behavioral health problems.

David Shern, PhD, is President and CEO of Mental Health America. For more information regarding the Mental Health America-Consortium partnership, e-mail

rcrowel@mentalhealthamerica.net.

Reference

  1. Kerr EA, McGlynn EA, Adams J, et al. Profiling the quality of care in twelve communities: Results from the CQI study. Health Aff 2004; 23:247-56.
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