Issues Exploration Forum (IEF): . Serious Mental Illness Dan Jonas, MD, MPH

1. Issues Exploration Forum (IEF):.Serious Mental IllnessDan Jonas, MD, MPH

2. Contribute to the establishment of an agenda to guide AHRQ’s comparative effectiveness research (CER) activities in mental health and substance abuse (MHSA) Began March 2010 to identify focus areas within MHSA where conducting CER is most likely to have an impact on: Reducing variation and uncertainty in clinical practice and outcomes Reducing methodological and conceptual uncertainty Reducing disease burden IEF Goals

3. Objectives Engage a diverse group of stakeholders Identify topics for future CER Identify topics that are well-suited for evidence synthesis (i.e. systematic reviews, comparative effectiveness reviews)

4. Framework for CER RTI-UNC EPC

5. Decided upon Serious Mental Illness High costs (direct and indirect) Early morbidity Early mortality Availability of interventions to potentially reduce the burden of disease Focus of the Forum

6. Adults with SMI and Mood or Psychotic Disorders SMI Psychotic Disorders Mood Disorders SMI 12-month prevalence = 8.3% Mood Disorders 12-month prevalence = 9.7% Psychotic Disorders including Schizophrenia lifetime prevalence = 1.5%

7. Series of 3 meetings engaging approximately 40 stakeholders (7/15, 7/30, 8/19) Initial generation of ideas and topics Grouped input into 3 themes for the in-person meeting Conceptual Framework for Research Patient-centered Care: Improving outcomes that matter to patients Reducing Disparities Process

8. Additional topic generation and prioritization Ultimately grouped similar ideas and topics under 21 prioritized themes Identification of topics for evidence synthesis or evidence generation Process

9. Upcoming publication AHRQ website once completed Topic nomination More information

10. Additional Information

11. Measurement and outcomes need consensus definitions Development of infrastructure for research: longitudinal studies, new investigators, and datasets Service delivery, treatment settings, and structuring the delivery of care Development of CER methodology Identify disparities and reasons for disparities and reevaluate the framework for researching disparities Role of the therapeutic relationship Strategies to personalize/individualize treatment Prioritized Themes

12. Prioritized Themes • Treatment approaches to avoid early mortality and morbidity • Role of the psychiatric hospital, lengths of stay, and transition support services after discharge • Retooling universities and education • Strategies to increase adherence to evidence-based guidelines and treatment regimens • Correctional programs and interventions for people involved with the criminal justice system • Interventions for people with comorbid medical illness or substance abuse • Prevention, early identification, trajectories, and developmental perspective

13. Dissemination and implementation Reducing barriers and improving access Mental health policy Modifiable factors: tobacco, exercise, and nutrition Alternatives to force or involuntary approaches Providing housing or social support Strategies to reduce stigma, prejudice, and discrimination Prioritized Themes

14. Total stakeholders participating = 39 total* Including: Federal representatives, researchers, clinicians, professional association representatives, individuals with expertise in racial/ethnic disparities, policymakers, payers, consumers, family members, advocates, representatives of the criminal justice system, and representatives of health systems. Federal entities included: Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, http://www.Clinicaltrials.gov/, Food and Drug Administration, National Institute of Mental Health, Office of Disability, Aging, and Long-term Care Policy, Substance Abuse and Mental Health Services Administration, VA Capitol Health Care Network, and VA Desert Pacific. Stakeholders * Some individuals represent more than one entity or area of expertise.