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
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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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.
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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.
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
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.
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
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.
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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.
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Contents
PROMOTING PERSON-CENTERED CARE, SHARED DECISION MAKING, AND PATIENT AND FAMILY ENGAGEMENT
Flipping the Script: Advancing Patient-Centered Care and Supported Decision Making
Trauma-Informed Care and the Ryan White Model of Delivery
Creating Hope Through Person-Directed Care, Decision Negotiation, and Collaboration
The Veterans Affairs Integrated Care Experience
Can We Provide Necessary Care for Substance Use and Mental Health Disorders in the United States?
Considering Essential Components of Care While Maintaining a Focus on Behavioral Health Equity
Implementation Science and Care for Mental Health and Substance Use Disorders
PROMISING STRATEGIES TO TRANSLATE KNOWLEDGE INTO PRACTICE AND MONITOR IMPLEMENTATION
Harnessing Implementation Science to Realize the Promise of Evidence-Based Practice
Using Evidence to Support Healthier Families and Better Lives
Integrating Primary Care and Behavioral Health Services in Coordinated Community Systems
KEY LEARNINGS FROM DAY ONE OF THE WORKSHOP
USING DATA TO IMPROVE CARE SERVICE DELIVERY AND PATIENT OUTCOMES
Examining the Opioid Epidemic Using Linked Data in Massachusetts
Advances in Mental Health Measurement
Achieving Population Well-Being Through Mental Health Integration and Team-Based Care
Adapting a Data Infrastructure to Address the Opioid Epidemic in Camden, New Jersey
DEVELOPING THE WORKFORCE FOR INTEGRATED CARE
The State of the Nation’s Behavioral Health Workforce
Assessing and Expanding the Clinical Workforce for Treating Substance Use Disorder in Colorado
Nurse Care Manager Model for Office-Based Addiction Treatment
Social Work Workforce: Spanning Multi-Focused Care Delivery Systems
Boxes, Figures, and Tables
BOXES
3 Changes Needed to Treat More Patients Adequately in Primary Care
4 Brief Summary of the Workshop’s Luncheon Discussions
FIGURES
1 An evidence-based model of trauma-informed health care
4 A model of how social determinants of health can lead to adverse mental health outcomes
5 Percentage of adults with no health insurance coverage by race and ethnicity
8 Opioid-related overdose deaths in Massachusetts
9 The Camden Coalition’s 16 domains of care to engage individuals in bedside care planning
TABLES
1 The Characteristics of Effective Trauma-Informed Care
2 Barriers to Substance Use Disorder Treatment, Initiation, and Engagement and Potential Solutions
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 |
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 |