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Issues Exploration Forum (IEF):

.Serious Mental IllnessDan Jonas, MD, MPH

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IEF Goals

• Contribute to the establishment of an agenda to guide AHRQ’s comparative effectiveness research (CER) activities in mental health and substance abuse (MHSA)

• Began March 2010 to identify focus areas within MHSA where conducting CER is most likely to have an impact on:– Reducing variation and uncertainty in clinical practice and

outcomes– Reducing methodological and conceptual uncertainty– Reducing disease burden

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Objectives

• Engage a diverse group of stakeholders

• Identify topics for future CER

• Identify topics that are well-suited for

evidence synthesis (i.e. systematic reviews,

comparative effectiveness reviews)

Framework for CER

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Focus of the Forum

• Decided upon Serious Mental Illness

– High costs (direct and indirect)

– Early morbidity

– Early mortality

– Availability of interventions to potentially reduce the burden of disease

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Adults with SMI and Mood or Psychotic Disorders

Mood Disorders

Psychotic Disorders

SMI

SMI 12-month prevalence = 8.3%

Mood Disorders 12-month prevalence = 9.7%

Psychotic Disorders including Schizophrenia lifetime prevalence = 1.5%

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Process

• Series of 3 meetings engaging approximately 40 stakeholders (7/15, 7/30, 8/19)

• Initial generation of ideas and topics • Grouped input into 3 themes for the in-person

meeting1. Conceptual Framework for Research

2. Patient-centered Care: Improving outcomes that matter to patients

3. Reducing Disparities

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Process

• Additional topic generation and prioritization

• Ultimately grouped similar ideas and topics under 21 prioritized themes

• Identification of topics for evidence synthesis or evidence generation

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More information

• Upcoming publication

• AHRQ website once completed

• Topic nomination

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Additional Information

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Prioritized Themes1. Measurement and outcomes need consensus definitions

2. Development of infrastructure for research: longitudinal studies, new investigators, and datasets

3. Service delivery, treatment settings, and structuring the delivery of care

4. Development of CER methodology

5. Identify disparities and reasons for disparities and reevaluate the framework for researching disparities

6. Role of the therapeutic relationship

7. Strategies to personalize/individualize treatment

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Prioritized Themes8. Treatment approaches to avoid early mortality and

morbidity9. Role of the psychiatric hospital, lengths of stay, and

transition support services after discharge10. Retooling universities and education11. Strategies to increase adherence to evidence-based

guidelines and treatment regimens12. Correctional programs and interventions for people involved

with the criminal justice system13. Interventions for people with comorbid medical illness or

substance abuse14. Prevention, early identification, trajectories, and

developmental perspective

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Prioritized Themes

15. Dissemination and implementation

16. Reducing barriers and improving access

17. Mental health policy

18. Modifiable factors: tobacco, exercise, and nutrition

19. Alternatives to force or involuntary approaches

20. Providing housing or social support

21. Strategies to reduce stigma, prejudice, and discrimination

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Stakeholders• Total stakeholders participating = 39 total*• Including:

o Federal representatives, researchers, clinicians, professional association representatives, individuals with expertise in racial/ethnic disparities, policymakers, payers, consumers, family members, advocates, representatives of the criminal justice system, and representatives of health systems.

o Federal entities included: Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, http://www.Clinicaltrials.gov/, Food and Drug Administration, National Institute of Mental Health, Office of Disability, Aging, and Long-term Care Policy, Substance Abuse and Mental Health Services Administration, VA Capitol Health Care Network, and VA Desert Pacific.

* Some individuals represent more than one entity or area of expertise.