by Michael D. Anestis, M.S.
I suspect that the vast majority of individuals reading this article, if it is not, in fact, a universal trend, already believe that mental health care in the United States performs well below its potential. Even with this in mind, however, yesterday's report by the National Alliance on Mental Illness (NAMI) on the performance of mental health care on both a state and national level was disturbing. The nation as a whole received a D grade for its performance. On the state level, there were six B's, eighteen C's, twenty-one D's, and six F's. Not a single state received an A grade. The states receiving failing grades were Arkansas, Kentucky, Mississippi, South Dakota, West Virginia, and Wyoming.
The criteria NAMI used in determining grades were as follows (information from http://www.nami.org/gtstemplate09.cfm?Template=/contentmanagement/contentdisplay.cfm&ContentID=75286):
Health Care and Promotion -- Basic measures, such as the number of programs delivering evidence-based practices, emergency room wait-times, and the quantity of psychiatric beds by setting.
Financing and Core Treatment/Recovery Services -- A variety of financing measures, such as whether Medicaid reimburses providers for all, or part of evidence-based practices; and more.
Consumer and Family Empowerment -- Includes measures such as consumer and family access to essential information from the
state, promotion of consumer-run programs, and family and peer education and support.
Community Integration and Social Inclusion -- Includes activities that require collaboration among state mental health agencies and other state agencies and systems.
Additionally, NAMI listed key innovations and urgent needs for each state.
Despite the horrific results on all levels, there are reasons to be hopeful in response to NAMI's findings. The primary reason for my optimism is that an advocacy group has managed to gain national attention regarding the complete disregard for empirically supported treatments (EST's) in every day practice. The bottom line is, we have a variety of empirically supported, time-limited psychosocial treatments for a number of mental illnesses. The problem is not that we do not know how to treat most mental illnesses, but rather that we simply do not use the treatments that have been shown to work. Most individuals are not simply without a solution to the problem, but in fact lack awareness that this problem even exists.
The first two criteria listed above place a heavy emphasis on the degree to which states integrate evidence-based practices, which is another term for EST's. The findings indicate that, by and large, integration of mental health care based upon empirical findings is limited. Obviously, this is a disappointing fact, but it is one about which most individuals trained in EST's are already aware. This leaves the field of clinical psychology in a familiar spot with familiar questions:
- What do we need to do to increase the degree to which EST's are integrated into every day practice?
- What can be done to facilitate conversation between those who favor EST's and those who do not? Convincing others of the need for EST's might be a more effective strategy than simply forcing their hand on the matter.
We believe there are a variety of things that need to be done, but the top priorities as we see it are as follows:
- Utilize mass media to disseminate scientific findings to as broad an audience as possible. This can include sites like Psychotherapy Brown Bag, podcasts, television programming, and social networking sites like Facebook and Twitter. In doing this, we can modernize our approach to teaching while increasing general awareness about the existence of EST's. Demand for such services is low not because they aren't desirable but because the market does not know that the product exists. In order for consumers to increase their demand, those capable of providing the product actually need to effectively sell it. The marketing of psychopharmacology is significantly stronger than the marketing of psychosocial interventions. In some cases, when the data supports the use of medication as a front line treatment (e.g. bipolar disorder, schizophrenia), this is a fine situation. In others, this is highly problematic and compounded further by the wide-spread marketing of faulty psychosocial interventions (e.g. equine therapy, rebirthing therapy) that perpetuate inaccurate perceptions of the field.
- Building off point #1, clinical psychology needs to brand itself. It needs slogans. It needs the faces of successful contributors to the field to maintain a certain degree of celebrity. It even needs celebrity advocates and accurate depictions in highly viewed television shows and films. It needs to shed the "ivory tower" persona that is not only counter-productive, but also entirely unrepresentative of the individuals who have devoted their lives to researching mental illness. None of these needs have any direct impact on the quality of a treatment, but they have an undeniable impact on the ability of the field to control information. How the field is seen impacts how individuals interact with it on both a personal and professional level. Currently, we are not winning the war of information.
- Increase the degree to which individuals involved in research converse and collaborate with clinicians. There are examples of effective collaborations across the globe and those examples should be applauded for their invaluable contributions to the field. At the same time, these examples mark the exception, not the rule. Increased collaboration will serve to diminish unnecessary animosity and misunderstandings. Researchers can not be the only ones aware of research.
Ultimately, what we would love would be to hear your ideas. These ideas can be broad ones or they can be smaller thougths that Psychotherapy Brown Bag might even be able to implement. Additionally, ideas can involve informing us of other organizations with similar goals with whom we can collaborate. The report by NAMI echoes the very sentiments that drove us to create this site. The more involvement from all sectors - researchers, clinicians, and non-professionals with a genuine interest in the topic -the better the chances of altering the current state of affairs. With that being said, we urge you to comment on this topic and to build a conversation amongst readers.
Mike Anestis is a doctoral candidate in the clinical psychology program at Florida State University
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