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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Key Policy Challenges and
Opportunities to Improve Care
for People with Mental Health
and Substance Use Disorders

PROCEEDINGS OF A WORKSHOP

Laurene Graig, Kaitlyn Friedman, and Joe Alper, Rapporteurs

Forum on Mental Health and Substance Use Disorders

Board on Health Care Services

Board on Health Sciences Policy

Health and Medicine Division

images

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Washington, DC
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Contract No. 200-2011-38807 (Task Order No. 75D30118F00073) with the Centers for Disease Control and Prevention, Purchase Order No. 75FCMC19PO036 with the Centers for Medicare & Medicaid Services, Contract No. HHSH250201500001I with the Health Resources and Services Administration, Contract No. HHSN263201800029I (Task Order No. HHSN26300025) with the National Institutes of Health, Contract No. HHSP223014000020B (BPA to HHSP23337073) with the Substance Abuse and Mental Health Services Administration, Contract/Task Order No. 3610X18PO178 with the U.S. Department of Veterans Affairs, and by Alkermes, American Board of Family Medicine, American College of Clinical Pharmacy, American Psychiatric Association, American Psychiatric Nurses Association, American Psychological Association, Association for Behavioral Health and Wellness, Council on Social Work Education, Education Development Center, Janssen Research & Development, National Association of Addiction Treatment Providers, Optum Behavioral Health, Otsuka America Pharmaceutical, PYA, Well Being Trust, and National Academy of Medicine. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-67220-7
International Standard Book Number-10: 0-309-67220-1
Digital Object Identifier: https://doi.org/10.17226/25690

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Key policy challenges and opportunities to improve care for people with mental health and substance use disorders: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25690.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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PLANNING COMMITTEE ON KEY POLICY CHALLENGES TO IMPROVE CARE FOR PEOPLE WITH MENTAL HEALTH AND SUBSTANCE USE DISORDERS1

MARGARITA ALEGRÍA (Co-Chair), Professor, Department of Psychiatry, Harvard Medical School, and Chief, Disparities Research, Massachusetts General Hospital

ALEXANDER ROSS (Co-Chair), Senior Behavioral Health Advisor, Office of Planning, Evaluation, and Analysis, Health Resources and Services Administration

COLLEEN BARRY, Fred and Julie Soper Professor and Chair, Department of Health Policy and Management, and Co-Director, Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health

JEFFREY BUCK, Senior Advisor for Behavioral Health, Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services

DARLA SPENCE COFFEY, President and Chief Executive Officer, Council on Social Work Education

LORI DUCHARME, Program Director for Health Services Research, Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health (until June 18, 2019)

SUSAN ESSOCK, Edna L. Edison Professor of Psychiatry, Emerita, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons

LARKE NAHME HUANG, Director, Office of Behavioral Health Equity and Justice-Involved, Substance Abuse and Mental Health Services Administration

R. KATHRYN MCHUGH, Assistant Professor, Department of Psychiatry, Harvard Medical School, and Associate Psychologist, Division of Alcohol and Drug Abuse, McLean Hospital

DEIDRA ROACH, Medical Project Officer, Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health (as of June 18, 2019)

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
×

MATTHEW TIERNEY, Associate Clinical Faculty, University of California, San Francisco, School of Nursing, and representing the American Psychiatric Nurses Association

MIKE WEAVER, Executive Director, International Association of Peer Supporters

TISHA WILEY, Branch Chief, Services Research Branch, National Institute on Drug Abuse, National Institutes of Health

Forum on Mental Health and Substance Use Disorders Staff

LAURENE GRAIG, Director, Forum on Mental Health and Substance Use Disorders, and Senior Program Officer

KAITLYN FRIEDMAN, Research Associate

RUHAMA GARI, Senior Program Assistant (September 2019–February 2020)

MICAH WINOGRAD, Senior Finance Business Partner

SHARYL NASS, Senior Board Director, Board on Health Care Services

ANDREW M. POPE, Senior Board Director, Board on Health Sciences Policy

Consultant

JOE ALPER, Writer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
×

FORUM ON MENTAL HEALTH AND SUBSTANCE USE DISORDERS1

COLLEEN BARRY (Co-Chair), Johns Hopkins Bloomberg School of Public Health

SUSAN ESSOCK (Co-Chair), Columbia University Vagelos College of Physicians and Surgeons (January 2019–October 2019)

HOWARD GOLDMAN (Co-Chair), University of Maryland School of Medicine (as of October 2019)

MARGARITA ALEGRÍA, Harvard Medical School and Massachusetts General Hospital

DARA BLACHMAN-DEMNER, Office of Behavioral and Social Sciences Research, National Institutes of Health

CARLOS BLANCO, National Institute on Drug Abuse, National Institutes of Health

MARTIN BROWN, PYA

JEFFREY BUCK, Centers for Medicare & Medicaid Services

DARLA SPENCE COFFEY, Council on Social Work Education

MICHAEL COLSTON, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, U.S. Department of Defense

W. PERRY DICKINSON, Practice Innovation Program, University of Colorado

KAREN DREXLER, Office of Mental Health & Suicide Prevention, U.S. Department of Veterans Affairs

THAD FLOOD, Otsuka America Pharmaceutical

ROBERT FORMAN, Alkermes

RICHARD FRANK, Harvard Medical School

MICHAEL FREED, National Institute of Mental Health, National Institutes of Health

CHELSEY GODDARD, Education Development Center

ALTHEA GRANT-LENZY, Centers for Disease Control and Prevention

PAMELA GREENBERG, Association for Behavioral Health and Wellness

LARKE NAHME HUANG, Substance Abuse and Mental Health Services Administration

KRISTIN KROEGER, American Psychiatric Association

HUSSEINI MANJI, Janssen Research & Development

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
×

R. KATHRYN MCHUGH, Harvard Medical School and McLean Hospital

TYLER NORRIS, Well Being Trust

KATHY PHAM, American College of Clinical Pharmacy

DEIDRA ROACH, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health

MARTIN ROSENZWEIG, Optum Behavioral Health

ALEXANDER ROSS, Health Resources and Services Administration

RUTH SHIM, University of California, Davis

MATTHEW TIERNEY, University of California, San Francisco, School of Nursing, and representing the American Psychiatric Nurses Association

RADM MICHAEL TOEDT, Indian Health Service

MARVIN VENTRELL, National Association of Addiction Treatment Providers

MIKE WEAVER, International Association of Peer Supporters

Forum on Mental Health and Substance Use Disorders Staff

LAURENE GRAIG, Director, Forum on Mental Health and Substance Use Disorders, and Senior Program Officer

KAITLYN FRIEDMAN, Research Associate

RUHAMA GARI, Senior Program Assistant (September 2019–February 2020)

MICAH WINOGRAD, Senior Finance Business Partner

SHARYL NASS, Senior Board Director, Board on Health Care Services

ANDREW M. POPE, Senior Board Director, Board on Health Sciences Policy

Consultant

JOE ALPER, Writer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
×

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

HORTENSIA AMARO, Northeastern University and Florida International University

SHELLY F. GREENFIELD, McLean Hospital and Harvard Medical School

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by PATRICK DELEON, Uniformed Services University of the Health Sciences. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Forum on Mental Health and Substance Use Disorders wishes to express its sincere gratitude to the planning committee co-chairs Margarita Alegría and Alexander Ross for their valuable contributions to the development and orchestration of this workshop. We also wish to thank all of the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, we want to thank the speakers and moderators, who generously shared their expertise and their time with workshop participants.

Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to the forum’s work. The sponsors include the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, National Institute of Mental Health, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, Office of Behavioral and Social Sciences Research, Substance Abuse and Mental Health Services Administration, U.S. Department of Veterans Affairs, and by Alkermes, American Board of Family Medicine, American College of Clinical Pharmacy, American Psychiatric Association, American Psychiatric Nurses Association, American Psychological Association, Association for Behavioral Health and Wellness, Council on Social Work Education, Education Development Center, Janssen Research & Development, National Association of Addiction Treatment Providers, Optum Behavioral Health, Otsuka America Pharmaceutical, PYA, Well Being Trust, and National Academy of Medicine.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Acronyms and Abbreviations

ACE adverse childhood experience
CAT computerized adaptive testing
CAT-MH computerized adaptive testing-mental health
CBO community-based organization
CMMI Center for Medicare & Medicaid Innovation
DoD U.S. Department of Defense
EBP evidence-based practice
ECHO Extension for Community Health Outcomes
ED emergency department
HRSA Health Resources and Services Administration
IOM Institute of Medicine
IPV interpersonal violence
MAT medication-assisted treatment
MHSUD mental health and substance use disorder
MOUD medications for opioid use disorder
NAMI National Alliance on Mental Illness
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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OBAT office-based addiction treatment
OUD opioid use disorder
PTSD posttraumatic stress disorder
SAMHSA Substance Abuse and Mental Health Services Administration
SUD substance use disorder
UCSF University of California, San Francisco
VA U.S. Department of Veterans Affairs
WHO World Health Organization
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Key Policy Challenges and Opportunities to Improve Care for People with Mental Health and Substance Use Disorders: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25690.
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Behavioral health and substance use disorders affect approximately 20 percent of the U.S. population. Of those with a substance use disorder, approximately 60 percent also have a mental health disorder. Together, these disorders account for a substantial burden of disability, have been associated with an increased risk of morbidity and mortality from other chronic illnesses, and can be risk factors for incarceration, homelessness, and death by suicide. In addition, they can compromise a person's ability to seek out and afford health care and adhere to treatment recommendations.

To explore data, policies, practices, and systems that affect the diagnosis and provision of care for mental health and substance use disorders, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine created the Forum on Mental Health and Substance Use Disorders. The forum activities are expected to advance the discussion and generate potential ideas on ways to address many of the most persistent problems in delivering mental health and substance use services. The inaugural workshop, held October 15-16, 2019, in Washington, DC, explored the key policy challenges that impede efforts to improve care for those individuals with mental health and substance use disorders. This publication summarizes the presentations and discussion of the workshop.

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