Observing the lack of a standard system in place to ensure that people with mental health and substance use disorders receive effective psychosocial interventions, the Institute of Medicine in a new report is proposing a framework to establish standards for such interventions to become available as part of routine clinical care.
The IOM convened an expert committee to identify key steps to ensure that evidence-based, high-quality care is provided to individuals receiving mental health and substance use care. The resulting report, “Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards,” was released July 14.
“We have some new challenges in mental health policy,” Mary Jane England, M.D., clinical professor of health policy and management at the Boston University School of Public Health and report co-author, told MHW. England cited the federal parity law and the Affordable Care Act (ACA) as “changing the whole landscape for insurance coverage.”
Both parity and the ACA present an opportunity for consumers with mental health and substance use disorders to have access to appropriate health care, noted England, who is also chair of the IOM Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders. “Although we have hundreds of very good psychosocial interventions, [they have] never been implemented evenly across systems,” she said.
England added, “There’s a big gap about what we know [about] science and what we’re implementing. We don’t have a common terminology. We developed a definition for psychosocial intervention so that people would have a consistent definition.”
Although the research has been done on the wide variety of psychosocial interventions that can be helpful in treatment, it has not been translated into a clinical perspective, said England. “Currently, there is no standard system to do that. We have to get people working together across all disciplines to make sure to use [the framework] in clinical practice,” she said.
Central to the framework is use of the consumer’s perspective to inform the overall process, according to the report. Evidence shows that consumers bring important personal experiences and knowledge of mental health and substance use disorders. “We need to do research and have an implementation strategy,” said England. “This will require consumer engagement.”
“If you ask a patient with serious mental illness what’s the most important thing they want to get out of treatment, they’ll say a place to live or a job, just like the rest of us,” England said. “The most important outcome is improving health functioning and well-being. Consumers need to become actively involved in any quality of standards development, which is what the ACA movement is all about."
The proposed framework highlights the need to:
- Support research to strengthen the evidence base on the efficacy and effectiveness of psychosocial interventions.
- Identify the key elements that lead to improved health outcomes.
- Conduct systematic reviews to inform clinical guidelines that incorporate these key elements.
- Develop quality measures of the structures, process and outcomes of the interventions.
- Establish methods for successfully implementing, sustaining and improving psychosocial interventions in regular practice.
Further research to expand the evidence base for psychosocial interventions, develop and test quality measures, and design and evaluate implementation strategies and policies should be built around the key elements that drive the effects of intervention, according to the report.
Among its recommendations, IOM notes that the U.S. Department of Health and Human Services (HHS) should designate an entity responsible for the development of quality measures to assess the structure, process and outcomes related to mental health and substance use disorders.
Additionally, a comprehensive quality framework should also consider the context in which interventions are delivered, including the characteristics of the consumer, qualifications of the provider, the clinic or setting in which care is delivered, the characteristics of the health system, and the regulatory and financial conditions that apply to the system, the report noted. Purchasers, plans and providers should design, evaluate and adopt strategies that are aligned across multiple levels to continuously improve the quality of psychosocial interventions.
The recommendations in the report are intended to assist policymakers, health care organizations and payers that are organizing and overseeing the provision of care for mental health and substance use disorders while navigating a new health care landscape, according to the report. The recommendations also target providers, professional societies, funding agencies, consumers and researchers.
The Association for Behavioral Health and Wellness (ABHW), the American Psychiatric Association (APA), the National Association of Social Work and other organizations, including HHS, sponsored the IOM report.
“Having evidence-based research helps us in terms of defining the benefits and measuring the effectiveness of care,” said Pamela Greenberg, ABHW president and CEO, told MHW. This sets us up for future work. Now we have to figure out who’s going to implement the framework and get us to the point where we know how to assess whether an intervention is evidence-based or not.
Greenberg added, “The importance lies in making sure the interventions that are delivered to consumers have an evidence base behind them. It’s one thing to have access to care — you have to make sure consumers have access to the right care that works.”
The APA applauded the IOM for its comprehensive new report and for offering recommendations on how best to establish the pathways for psychosocial intervention standards, or nonmedication treatments for individuals with mental health and substance use disorders. “The ongoing focus on quality improvement and increased use of health information technology will be key to improving outcomes for our patients,” APA President Renée Binder, M.D., said in a statement.
Plan of action
The IOM is convening a meeting to begin implementing the recommendations in late September or early October, said England. “It’s really a working meeting,” she said, one that would include providers, consumers, payers, researchers, employers and purchasers.
“We’re going to develop a plan of action,” she said. “The meeting will include representation from all stakeholders. We’ve done the report. Now we have to get a plan.”
It’s important that each stakeholder group educates its own constituents and discusses this when they come to the meeting in the fall, England said. “It’s very timely now,” she said. There’s an “urgency of getting a common approach,” she said. “We recommend stakeholders come together to use this framework for improving patient outcomes.”
For a copy of the IOM report, “Psychosocial Interventions for Mental and Substance Use Disorders,” visit http://iom.nationalacademies.org.
Defining psychosocial interventions
The Institute of Medicine in its new report released July 14 defines psychosocial interventions as “interpersonal or informational activities, techniques, or strategies that target biological, behavioral, cognitive, emotional, interpersonal, social, or environmental factors, with the aim of improving health functioning and well-being. Examples include psychotherapies, such as cognitive behavioral therapy, which aims to correct inaccurate or negative patterns of thinking; peer-support services; and community-based treatment.”
The IOM is convening a meeting of all stakeholders in early fall to develop a plan of action based on psychosocial intervention standards recommended in a new report.