Let's take step to improve the science of treating serious mental illness

Let's take step to improve the science of treating serious mental illness
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Promoters of mental health programs and some in Congress are charging the administration with abandoning science because the Substance Abuse and Mental Health Services Administration (SAMHSA) is changing how it compiles a listing it maintains of privately sold mental health programs.

The opposite true. The Assistant Secretary of Mental Health and Substance Use Disorders, Dr. Elinore McCance-Katz is addressing the fact that the listings were never based on science and desperately needed reform.

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Congress recognized this when it passed the bipartisan Helping Families in Mental Health Crisis Act originally proposed by former Reps Tim MurphyTim MurphyPennsylvania New Members 2019 Poll: Lamb has double-digit lead in Pennsylvania House race Jordan weathering political storm, but headwinds remain MORE (R-Pa.) and Eddie Bernice JohnsonEddie Bernice JohnsonK Street works to court minority lawmakers Black Caucus huddles as talk of term limits heats up The Year Ahead: Dems under pressure to deliver on green agenda MORE (D-Texas). As a result of that legislation, Dr. McCance-Katz has strengthened the office of the medical director, formed a Policy Lab and is trying to make science foundational to everything at SAMHSA.

 

In the United States, there is no licensing or regulation of education modules or talk therapies. Anyone can claim she has one that works. SAMHSA helped them by maintaining what it called a National Registry of Evidence-Based Programs and Practices (NREPP). It is little more than a collection of privately developed workshops and training sessions that SAMHSA essentially certifies as being evidence-based.

SAMHSA then encourages states to use their $2.2 billion federal mental health and substance use block grants to buy the listed “programs and practices” from the vendors and the vendors use SAMHSA certification in their own promotional materials.

So there is big money attached to getting in the database and a lot of concern from those in it because SAMHSA is taking it in-house and making it more scientific.

Little of what’s in NREPP are actual treatments, and few are based on science. For SAMHSA to list a program as being “evidence-based” it should require a program to have (a) independent proof that it (b) improves a meaningful outcome in (c) people SAMHSA is intended to serve, adults and children with serious mental illness or substance use disorders.

I discovered in my research is little of what is in NREPP to meet those three criterion. The studies lack independence and often come straight from those who invent, sell, and profit from them. The outcomes being measured are not meaningful, metrics such as reductions in homelessness, arrests, incarcerations, hospitalizations, and suicides.

They are soft measures like satisfaction, feeling of wellness, empowerment, hopefulness, and resiliency. In fact, a program promoter could measure ten outcomes, find nine are not improved or even made worse, and then submit the one positive finding as proof the program is evidence-based. Clearly something is wrong.

The studies promoters are submitting are often not conducted among the seriously ill or substance abusers SAMHSA was founded to serve. As Twitter has proven, show the public pictures of cute cats and they smile.

Now all you have to do is tabulate the results and submit them to SAMHSA and you’ve got an “evidence-based” program that “improves mental health.” Taking people bowling could probably gain NREPP certification because it makes people happier.

Dr. Sally Satel of Yale testified in front of an Oversight and Investigations subcommittee of the House Energy and Commerce Committee hearing convened by former Congressman Tim Murphy to investigate problems at SAMHSA. She found that “of the 288 programs listed, four by my count specifically designated people with severe illness as their recipients.”

The hearings led Congress to pass legislation attempting to embed science, rather than political correctness, in the DNA of SAMHSA. Now that SAMHSA has a robust Office of the Medical Director and a new Policy Lab, it is appropriate to take NREPP in-house. This new move is not anti-science, it is key to it.

DJ Jaffe is the the executive director of Mental Illness Policy Org a non-partisan think-tank on serious mental illness. And the and author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.