This Month’s Highlights

As full implementation of the Affordable Care Act (ACA) in 2014 approaches, researchers are analyzing past data in an effort to reduce uncertainty among program administrators and providers, as indicated by two studies in this month’s issue. The ACA is expected to cause shifts in funding for specialty mental health and substance abuse treatment. To provide a baseline for understanding future changes, Katharine R. Levit, B.A., and colleagues analyzed 1986 and 2005 data on funding sources for specialty behavioral health care, including out-of-pocket payments, private insurance, and public funding. They documented substantial changes for hospital-based care, office-based providers, and specialty treatment centers. With ACA’s full implementation, spending will likely increase under private insurance and Medicaid. Parity in private plans will also push a larger share of payments to office-based professionals from out-of-pocket payments to private insurance, the authors conclude (page 512). In states that opt to expand Medicaid, many low-income individuals will gain access to treatment. To assess unmet need for substance abuse treatment among adults expected to be income eligible for Medicaid in 2014—household income less than 138% of the poverty level—Susan H. Busch, Ph.D., and colleagues analyzed data from two groups of respondents to the 2008 and 2009 National Survey on Drug Use and Health: current low-income Medicaid enrollees and currently uninsured individuals who will become Medicaid eligible. The rate of substance use disorders was significantly higher in the latter group (14.6% versus 11.5%). The findings suggest that Medicaid expansion will reduce unmet need for substance abuse treatment, the authors conclude (page 520).

In recent years the U.S. Department of Veterans Affairs (VA) has taken a leadership role in mental health services research. Seven studies in this issue attest to the range of topics currently under investigation by VA researchers. A group that examined longitudinal prescribing patterns for nearly 2,000 veterans with newly diagnosed schizophrenia found that although most patients received guideline-concordant care, antipsychotic polypharmacy was commonly used as initial treatment (page 527). Two studies that assessed the effectiveness of family group therapy for veterans with traumatic brain injury found that participating veterans reported less anger expression and more social support and occupational activity and family members reported decreased burden and increased empowerment (page 534); in a focus group, family members described “powerful experiences of connecting” with a wider social network and reconnecting with their loved ones (page 541). Another VA research group that focused on differences between veterans and adult civilians who responded to a national telephone survey about health and behaviors found that veterans had poorer general health and higher rates of lifetime anxiety disorders (page 547). More than 7,000 veterans discharged from inpatient to outpatient care responded to a VA survey about their experiences, and researchers who examined the data found that patients who felt more informed about treatment and more involved in their care during hospitalization were more likely to participate in mental health care within seven and 30 days of discharge (page 554). Beginning in 2004, the Veterans Health Administration (VHA) has undergone significant organizational transformation as part of a strategic plan to enhance mental health services. An analysis of national data from six annual workplace surveys showed that VHA psychiatrists have become more satisfied with their workplace in several key areas (page 563). Finally, treatment dropout among veterans with serious mental illness was found to be lower among those whose utilization patterns—more outpatient primary care and mental health visits—suggested better engagement. However, veterans with a history of homelessness or service in Iraq or Afghanistan were more likely to drop out (page 594).

The field of dissemination and implementation (D&I) has thrived in recent years through research initiatives by federal agencies and states. D&I researchers seek the best ways to introduce evidence-based practices into real-world settings. This type of “translation” was once seen as a hand-off from one world to another. But D&I researchers are now finding that partnerships blending the worlds of research, policy, and practice are the way to go. In the Research and Services Partnerships column (formerly the Public-Academic Partnerships column), David A. Chambers, D.Phil., and Susan T. Azrin, Ph.D., from NIMH’s Division of Services and Intervention Research, describe three partnered D&I projects that “exemplify the shift in D&I research from a top-down, linear view of the spread of information and interventions to a complex, dynamic cycle of interaction among researchers, practitioners, and policy makers” (page 509).