Feds freeze mental health practices registry

Federal health officials recently froze a program aimed to educate the public and provide information about evidence-based mental health and substance abuse treatment programs.

Established in 1997, the National Registry of Evidence-based Programs and Practices was overseen by the Substance Abuse and Mental Health Services Administration, under the US Department of Health and Human Services.

In order to be listed on the registry, programs had to undergo a review process by the administration to determine the regimen’s effectiveness. Programs could be self-nominated for review or identified by the administration for review.

The registry had been managed by Development Services Group Inc., an outside organization that specializes in assessing behavioral health programs and contracted by the mental health services administration. Participants of the registry were sent an email notifying them of the suspension.

The email reads, “It is with great regret that we write to inform you that on December 28, 2017, we received notification from SAMHSA that the NREPP contract is being terminated for the convenience of the government.

“We are deeply saddened by the government’s sudden decision to end the NREPP contract,” the letter said, requesting that all comments and concerns be directed to the mental health services administration.

A statement posted on the program’s website this week says that “Although the current NREPP contract has been discontinued, SAMHSA is very focused on the development and implementation of evidence-based programs in communities across the nation. SAMHSA’s Policy Lab will lead the effort to reconfigure its approach to identifying and disseminating evidence-based practice and programs.”

A new approach

The Policy Lab is a program funded through the 21st Century Cures Act, which was signed by President Barack Obama in December 2016. The lab aims to “promote evidenced-based practices and service delivery models through implementation grants and evaluation” by building on existing resources like the registry.

In a statement published Thursday evening, SAMHSA’s Assistant Secretary for Mental Health and Substance Use, Dr. Elinore McCance-Katz, said that the NREPP, as currently configured, simply wasn’t serving its intended purpose. “For the majority of its existence, NREPP vetted practices and programs (that were) 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,” she said.

McCance-Katz pointed out that in its current form, the program was simply identifying too few or no results with common search terms such as “medication-assisted treatment” or “schizophrenia.” She stressed that the current review system wasn’t up to par. “This is a poor approach to the determination of (evidence-based practices),” said McCance-Katz.

Rather than continue the registry as is, McCance-Katz said a more stringent process for reviewing practices was going to be undertaken utilizing SAMHSA’s own technical resources and expertise within the agency, and making use of “local and national experts and (that will) assist programs with actually implementing services that will be essential to getting Americans living with these disorders the care and treatment and recovery services that they need,” she said.

In fact, a recent paper in the International Journal of Drug Policy found the registry contained programs with limited studies evaluating them or studies with very small sample sizes to accurately measure their success.

However, no specific details regarding when the new program will begin and when results will be made public were provided. The current registry will remain online as of now, but will not be updated.

‘It came with such a blinding speed’

SAMHSA’s statement was the first public response it had provided since the email it sent out two weeks ago announcing the registry would be frozen. That announcement took mental health advocates by surprise. “It came with such a blinding speed,” said Richard Yep, CEO of the American Counseling Association. “People were initially really shocked by the whole thing.”

Without any additional information from SAMSHA, Yep said mental health professionals were left to speculate what was next and why the registry had stopped.

The registry has been a go-to tool for many members of the association, he said, helping counselors “move services faster to those who are most in need.” Ending the registry this way was short-sighted he said.

Yep admits that the program wasn’t flawless but said “it has stood the test of time.” He questioned why a replacement wasn’t up and running to take over the work and called the decision to freeze the registry short-sighted. “Why didn’t you start that system up and compare it side-by-side? Instead, to just cut it off, it makes no sense professionally.”