Measuring Specific Mental Illness Diagnoses with Functional Impairment Workshop Summary (2016) / Chapter Skim
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2 Data Needs and Studies Planned
2 Data Needs and Studies Planned
Pages 7-20
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From page 7... ...
Manderscheid noted key concepts that are important in discussing estimation: prevalence, the total number of cases for a defined period of time; incidence, the number of new cases for a defined period of time; treated prevalence, the number of cases under care in specialty mental health settings; and community prevalence, the total number of cases in the community, including those under care. From the 1950s to the 1970s, the field relied on treated prevalence and defined persons with mental illness by their diagnoses.
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From page 8... ...
In the 1990s, the legislation that created SAMHSA in 1992, Public Law 102321, the Alcohol Drug Abuse Mental Health Administration Reorganization Act, required that SAMHSA develop a definition of adults with "serious mental illness" and that this definition be operationalized and applied to the Community Mental Health Services Block Grant Program. Manderscheid explained that the development of the new definition started with diagnosis and disability and eliminated duration.
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From page 9... ...
He pointed out that there has been congressional interest in providing funds to the behavioral health world to adopt electronic health records. Manderscheid also remarked that the field is in the midst of another transition from focusing on problems using deficit-based measures (i.e., diagnoses and functional impairments)
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From page 10... ...
asked about informed consent issues for research using electronic health records and about how the need for covariates -- which are available in population studies, but typically not in electronic health records -- could be addressed. Manderscheid replied that there is a need for incorporating a systematic plan into the design of any system for electronic health records, not only obtaining permission for the possible use of the data in research, but also advance directives for the assignment of medical power of attorney and permission for sharing private information.
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From page 11... ...
Darrel Regier (Uniformed Services University) added that one of the things the APA revision team for the DSM-5 has been trying to do with the DSM-5 cross-cutting measures and the WHODAS disability measure is to eventually include self-report measures in electronic health records.
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From page 12... ...
He said that, in his view, electronic health records are a wonderful source to work with, but they will never do away with the need to collect survey data as a complement. A NEW NATIONAL INSTITUTE OF MENTAL HEALTH INITIATIVE Lisa Colpe (National Institute of Mental Health)
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From page 13... ...
The planned survey module topics include comprehensive demographics; mental disorders (including substance use and personality measures) ; suicidality (including past and recent suicidal behavior, access to firearms)
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From page 14... ...
Olfson asked Colpe whether the NIMH team has given any thought to oversampling low income people, ethnic or racial minorities, or other groups of policy interest. Colpe replied that right now NIMH only plans to oversample by age groups.
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From page 15... ...
They also planned the instrument layout so that the most important questions are at the beginning. Regier noted that some disorders of high interest in the context of disability issues, such as schizophrenia and autism spectrum disorder, are not included in the new NIMH survey.
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From page 16... ...
For those conditions Vos said that the Global Burden of Disease study tends to rely on different data collection methods, and the researchers pay special attention to selection bias issues. For the drug use disorders, they use indirect estimates that combine survey data, mental health records, needle exchange program data, and judiciary data.
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From page 17... ...
In terms of prevalence rates for schizophrenia, they found that far more people with schizophrenia are being served in primary care than are being served in the institutions, although the most severely ill may be in institutions. Still on the subject of sampling frames, Kilpatrick raised a point about the low level of long-term inpatient mental health care that is available, which results in a disproportionate number of people with mental illness being in prisons and jails before they are incarcerated or adjudicated.
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From page 18... ...
Data are submitted when a person is admitted, at 90 days, and when there is a change. The second data source is a new Medicare payment mechanism for collecting claims data for people who use inpatient psychiatric facilities.
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From page 19... ...
The Healthy People 2020 initiative has made major investments in this area and will continue to do that over time.5 There are opportunities to build some synergies on these topics. Colpe responded that the new NIMH survey is not expected to replace SAMHSA's existing procedures for estimating serious mental illness.
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