National Institute of Mental Health, Division of Services and Intervention Research, Bethesda, MD, USA,
J Ment Health Policy Econ. 2021 Dec 1;24(4):137-142.
Decades of research that predate the COVID-19 pandemic demonstrate that most people with mental health needs are not receiving adequate care. The inequities between those who need care and those who receive adequate care are larger for racial and ethnic minority groups and people living in underserved communities. The pandemic is associated with an exacerbation of these inequities, resulting in increased morbidity and mortality for the most vulnerable populations.
This Perspective summarizes longstanding and evolving challenges to the provision of high quality care for people with mental illness, describes the National Institute of Mental Health's (NIMH) commitment to addressing those challenges, and embeds salient research priorities most germane to the health policy readership of this journal.
Example funding announcements and extant funding priorities are highlighted to demonstrate NIMH's commitment to health services research during the pandemic. The collaborative care model is presented as an evidence-supported service delivery model that could be delivered via telehealth. Recent studies that compare the utilization of routine telehealth services during the pandemic, when compared to in-person services pre-pandemic, are summarized.
In FY2020, NIMH invested $171,194,275 in health services research. Over the past two years, NIMH led or participated on dozens of funding announcements that call for mental health services research to help improve the provision of care for people with mental illness. Service delivery models like collaborative care can offer effective intervention via telehealth. The practice community can deliver routine services via telehealth at volumes similar to pre-pandemic in-person levels. However, wide variation in telehealth utilization exists, with inequities associated with racial and ethnic groups and underserved rural locations. A limitation is that clinical outcomes are not routinely available from administrative datasets.
There continues to be an urgent need for health policy research and collaboration with the health policy community as part of the research enterprise.
NIMH encourages and often requires strong research practice partnerships to help ensure findings will be of value to end users and make their way into the practice setting. There is a need to study pandemic related changes in financing, delivery, receipt, and outcomes of mental health care.
Despite robust evidence, clinical practice guideline recommendations, and established financing mechanisms, uptake of service delivery models that can be delivered in part or in full via telehealth (e.g., the collaborative care model) is poor.
In the era of COVID-19, the charge to the mental health services research community is urgent: (i) develop strategies to better implement, scale, and sustain existing evidence-supported treatments and services and (ii) develop, test, and evaluate new solutions to improve access, continuity, quality, equity, and value of care.
早在 COVID-19 大流行之前的几十年里，研究就表明，大多数有心理健康需求的人都没有得到足够的照顾。在需要护理的人和得到充分护理的人之间，种族和民族少数群体以及生活在服务不足社区的人之间存在更大的差距。大流行导致这些不平等现象恶化，使最脆弱人群的发病率和死亡率上升。
本观点总结了长期存在的、不断演变的为精神病患者提供高质量护理的挑战，描述了美国国家心理健康研究所（NIMH）解决这些挑战的承诺，并嵌入了与该杂志的卫生政策读者最相关的突出研究重点。
突出显示了示例资助公告和现有的资助重点，以展示 NIMH 在大流行期间对卫生服务研究的承诺。提出协作式护理模式作为一种有证据支持的服务提供模式，可以通过远程医疗提供。总结了最近比较大流行期间常规远程医疗服务使用情况与大流行前的面对面服务使用情况的研究。
在 2020 财年，NIMH 在卫生服务研究方面投资了 171,194,275 美元。在过去的两年中，NIMH 领导或参与了数十项资助公告，呼吁开展心理健康服务研究，以帮助改善对精神病患者的护理。协作式护理等服务提供模式可以通过远程医疗提供有效的干预措施。实践社区可以通过远程医疗提供常规服务，数量与大流行前的面对面水平相似。然而，远程医疗的使用存在广泛差异，与种族和民族群体以及服务不足的农村地区存在不平等现象。一个限制是，从管理数据集通常无法获得临床结果。
作为研究工作的一部分，继续迫切需要开展卫生政策研究和与卫生政策界的合作。
NIMH 鼓励并经常要求建立强大的研究实践伙伴关系，以确保研究结果对最终用户有价值，并使其进入实践环境。需要研究与大流行相关的心理健康保健的融资、提供、接受和结果变化。
尽管有强有力的证据、临床实践指南建议和既定的融资机制，但通过远程医疗（例如协作式护理模式）部分或全部提供的服务提供模式的采用率仍然很低。
在 COVID-19 时代，精神卫生服务研究界的任务紧迫：（i）制定战略，以更好地实施、扩大和维持现有的循证治疗和服务，以及（ii）制定、测试和评估新的解决方案，以改善获取、连续性、质量、公平性和护理价值。
