HHS suspends registry of evidence-based mental health and substance misuse interventions

The Trump administration has suspended a national registry intended to provide information on evidence-based mental health and substance misuse programs, and plans to shift oversight of the review process for programs included in the database to an internal team.

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Background on database

The National Registry of Evidence-based Programs and Practices (NREPP), established in 1997, is managed by HHS' Substance Abuse and Mental Health Services Administration (SAMHSA). Previously, SAMHSA has relied on contractors to conduct an independent review of mental health and substance misuse programs and identify those that are supported by scientific evidence, according to the Washington Post. The database since 2015 also has featured data demonstrating that certain interventions are ineffective so providers know which treatment options to avoid.

However, the database has come under fire in recent years, the Post reports. Dennis Gorman, a professor at Texas A&M University's Department of Epidemiology & Biostatistics, published a paper in July 2017 contending that the database was not "weeding out" ineffective programs. Gorman in the paper said of the 113 interventions added to the database between September 2015 and January 2017, 14% relied upon a single, non-peer-reviewed article, while 45% of them relied on a single peer-reviewed article.

Details on suspension

According to the Post, SAMHSA in December 2017, notified the contractor hired to work on the registry, Development Services Group, that it was ending the contract "for the convenience of the government."

However, mental health advocates said the agency in September 2017 had already frozen the registry, adding that the suspension has halted the publication of assessments for about 90 new programs, the Post reports.  

On Thursday, Elinore McCance-Katz, SAMHSA's assistant secretary for mental health and substance use, in a statement said SAMHSA froze the registry because the database was a "poor approach to the determination of" evidence-based programs and treatments. She said the database has for most of its existence "vetted practices and programs submitted by outside developers—resulting in a skewed presentation of evidence-based interventions, which did not address the spectrum of needs of those living with serious mental illness and substance-use disorders."

As it is currently designed, she added, the database "often produces few to no results" when routine search terms—such as "medication-assisted treatment"—or diseases and conditions, such as schizophrenia, are entered.

Separately, SAMHSA spokesperson Christopher Garrett said, "The federal government should not be in the business of having a single contractor determine winners and losers in behavioral health care," adding that the agency's job is to "lead the efforts to rapidly institute evidence-based practices in all behavioral health treatment programs."

Handing off to a new agency

Officials said SAMHSA's National Mental Health and Substance Use Policy Laboratory, or Policy Lab will take over the program's responsibilities—including the assessment of programs for inclusion in the database.

According to the Washington Post, the Policy Lab was established in 2016 under the 21st Century Cures Act. McCance-Katz said the Lab's aim is to "periodically review programs and activities" related to addressing mental illnesses and substance use disorders, in addition to spotting programs "that are duplicative and are not evidence-based, effective, or efficient."

Spokesperson Brian Dominguez said the Policy Lab is "working closely" with various parts of the agency to "institute an even more scientifically rigorous approach to better inform the identification and implementation of evidence-based programs and practices." According to McCance-Katz, the new process will involve collaboration with CDC, the National Institutes of Health, and other organizations that can "comment on what constitutes evidence-based practices."

According to the Post, officials have not provided details on how the new approach will operate, when it will launch, or whether it will include programs and interventions that have already been assessed.

Reaction

Mental health experts and lawmakers have voiced concern about the database's suspension and the move to bring the assessment process in-house, the Post reports.

For instance, Catherine Tucker, the president of the Association for Child and Adolescent Counseling, said shifting the review process in-house could politicize the evaluation process. "NREPP is one of the most important tools we have. Nobody has a financial stake," she said. "It's an impartial, nonpartisan, trustworthy source that represents thousands and thousands of hours of work."

Sen. Rob Portman (R-Ohio) said he is "concerned and looking into" why the registry was suspended. "I've long believed we must use federal funds for evidence-based programs that work and we must continue to make this a priority," he said.

Rep. Grace Meng (D-N.Y.), said she was "shocked to learn that the NREPP contract has been terminated as an opioid epidemic continues to shake our nation." Meng said she is "determined to find out why SAMHSA has made such a mind-boggling decision" (Hellmann, The Hill, 1/10; Sun/Eilperin, Washington Post, 1/10; Gorman, International Journal of Drug Policy, July 2017).

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