RTI-UNC EPC Issues Exploration Forum (IEF):. Serious Mental Illness Dan Jonas, MD, MPH

RTI-UNC EPC 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

RTI-UNC EPC 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 RTI-UNC EPC

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

RTI-UNC EPC 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%

RTI-UNC EPC 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 meeting 1.Conceptual Framework for Research 2.Patient-centered Care: Improving outcomes that matter to patients 3.Reducing Disparities

RTI-UNC EPC 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

RTI-UNC EPC More information Upcoming publication AHRQ website once completed Topic nomination

RTI-UNC EPC Additional Information

RTI-UNC EPC Prioritized Themes 1.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

RTI-UNC EPC Prioritized Themes 8.Treatment approaches to avoid early mortality and morbidity 9.Role of the psychiatric hospital, lengths of stay, and transition support services after discharge 10.Retooling universities and education 11.Strategies to increase adherence to evidence-based guidelines and treatment regimens 12.Correctional programs and interventions for people involved with the criminal justice system 13.Interventions for people with comorbid medical illness or substance abuse 14.Prevention, early identification, trajectories, and developmental perspective

RTI-UNC EPC 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

RTI-UNC EPC 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, 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.