May is recognized as Mental Health Month and dedicated to raising awareness of mental health issues in the United States. It’s a critical topic to address, as the extent and burdensome nature of mental illness makes improving mental health care an urgent need.
The global burden of disease attributed to mental illness and substance use disorders is substantial. Among American adults alone, approximately 20 percent—45 million people—have a mental, behavioral, or emotional disorder, although the prevalence of these problems varies among racial, ethnic, age, and gender groups. Mental illness, from mild impairment to significant disability, can have a strong influence on a person’s quality of life and physical health. The impact of mental illness extends not only to family and friends, but also to the society overall, for example, in lost productivity and treatment costs.
Here at PCORI, we’re supporting research to help patients and those who care for them make better-informed decisions about mental health and health care. In fact, mental illness is the focus of one of our largest collections of studies funded under our National Priorities for Research, with several dozen projects addressing this problem in some way. Our work, with its emphasis on patient-centered comparative effectiveness research (CER), complements that of other organizations that fund mental health research, including federal government agencies.
The mental health community has been engaged in PCORI’s work from the beginning. From participating in workshops to providing comments on our national priorities, individuals and national organizations, such as Mental Health America, the National Alliance on Mental Illness, the American Psychiatric Association, American Psychological Association, American Academy of Child and Adolescent Psychiatry, and others, have played an important role in shaping our agenda. They have helped identify the questions patients and those who care for them need answered to make more-informed clinical decisions that reflect their needs and preferences. We look forward to continued collaboration, including the eventual dissemination and implementation of results from our patient-centered research.
A Snapshot of What We Fund
In mental health, as in other fields, we seek to fund patient-centered research that compares health outcomes of two or more preventive, diagnostic, treatment, or healthcare system approaches. PCORI-funded researchers partner with patients, caregivers, clinicians, and other stakeholders to ensure that the studies will provide information relevant to patients’ care. In this way, by focusing on the questions and outcomes most important to patients, we believe the research we fund will be more likely to help them and those who care for them make better-informed decisions about care.
Some projects are looking at more-effective tools and methods for enhancing patient and clinician decision making to improve mental health outcomes. Others are assessing mental health outcomes in conjunction with treating other health conditions, like a study in Washington State that looks at ways to improve care for depression and pain in patients with multiple sclerosis, and another project in North Carolina that focuses on psychological distress among critical illness survivors and their informal caregivers. And we’ve made mental health one of the areas of focus in our Pragmatic Clinical Studies and Large Simple Trials Funding Announcement; specifically, evaluating outcomes of care models that integrate mental health services into primary care.
Mental health in underserved populations
Underserved populations are among the particular areas of focus in our mental health research projects. Our authorizing legislation charges us with taking into account health disparities in healthcare delivery and outcomes as we advance our research agenda. So one of our National Priorities for Research is Addressing Disparities, which includes studying the healthcare approaches required to achieve best outcomes in different populations, especially those that tend to have less access to health resources. These include certain racial and ethnic groups; children and adolescents; low-income individuals; people over age 65; rural residents; and lesbians, gays, bisexuals, and transgender people. These groups receive fewer mental health services and encounter more barriers to illness management than the general population.
Some of our projects focus on increasing access to appropriate mental health care, enhancing the mental health workforce, or empowering patients and caregivers. For example, to improve access to care, in one California study, people with serious mental illness train others to navigate the healthcare system. This intervention combines three approaches: integrated care, patient education, and skill building. The study compares the outcomes of patients aided by trained peer navigators with those of patients not assigned a navigator.
Another investigator in California is studying the long-term (3-year) outcomes of community engagement where community agencies work together to tailor depression care to their communities, compared with technical assistance, where individual community agencies use toolkits to improve depression services for depressed patients. This study could be important to address some long-standing gaps in knowledge related to access to care, quality of care, and outcomes of care among patients with depression.
A study in North Carolina, meanwhile, seeks to empower parents to take advantage of mental health services available for their children. The researchers, based in North Carolina, are testing a tailored intervention that bridges cultural differences to improve Latinos’ use of child mental health services. The project compares the children’s mental health outcomes after parents have participated in either the tailored intervention or a parent support group.
A Commitment to Addressing a Substantial Health Burden
As we’ve often noted, PCORI has a broad and challenging legislative mandate. We’re called on to pay particular attention to disease incidence, prevalence, and burden, with an emphasis on chronic conditions. We’re told to take into account health disparities in terms of delivery and outcomes of care, and the potential for new evidence to improve patient health, well-being, and quality of care. And we’re instructed to be sure that we factor into our work patient needs, outcomes, and preferences, and the relevance of our funded research to patients and clinicians in making informed health decisions.
We translate those mandates into all of the work we do, and we’re particularly pleased to address so many of these critical concerns in our diverse and growing portfolio of mental health research projects. We look forward to working closely with you as we continue our activity in this area.