Research to Improve Mental Health for All

Grayson Norquist, MD, MSPH, and Joe V. Selby, MD, MPH

Around one in five American adults lives with a mental illness, such as depression, bipolar disorder, or an anxiety disorder, according to the National Institute of Mental Health. Many of these people also have serious, often preventable, physical illnesses, but often don’t get the care they need for those problems. As a result, people with serious mental illnesses die on average 10 to 20 years earlier than others.

These illnesses affect minority communities to a substantially greater degree than they do non-Hispanic white populations. Due to the stigma associated with mental illness, difficulty accessing effective treatments and qualified providers, and a lack of clear evidence to support various treatment choices, people in minority communities are less likely to receive needed treatment or counseling than non-Hispanic whites.

Too often, we know what the problems are but don't yet have the information needed to solve them. That's where research can help, by identifying which of the many available approaches to mental healthcare will work best for which patients, especially those living in minority communities. That’s the kind of research the Patient-Centered Outcomes Research Institute (PCORI) funds. By engaging patients and other healthcare stakeholders in all the work we do, including the studies we support, we can ask the questions and produce the results that help people make better healthcare decisions.

PCORI has funded 107 patient-centered clinical comparative effectiveness research studies related to mental and behavioral health—a $400 million commitment. This includes $58 million to support 25 studies that emphasize addressing racial and ethnic disparities in mental and behavioral healthcare in an effort to improve care and outcomes in these communities.

A number of these projects focus on the effectiveness of peer navigators—people who have experienced and overcome their own health problems and who have received training to guide others through the healthcare system. You could call it patients helping patients.

Two of those peer navigators are Sonya Ballentine and Marilyn Perez-Aviles, who have worked on PCORI-funded projects led by Patrick Corrigan, PsyD, of the Illinois Institute of Technology. Both projects focus on helping minority populations with serious mental illness living in Chicago.

“Peer navigators know exactly what it’s like to have no hope in yourself or to be without a job or to have a substance use disorder,” says Perez-Aviles. “They can empathize, and they can help either by taking action and helping schedule appointments or by doing something like listening to people who have reached their breaking point.”

Corrigan and his colleagues found those who worked with peer navigators over a one-year period reported having a better quality of life and more appointments with clinicians than did people who received usual care during the same period. The team published the results in Psychiatric Services. However, it wasn’t just the patients in the study who benefited. The peer navigators themselves felt empowered and proud of the difference they were making in their communities.

“My life has changed in profound ways,” Ballentine says. “PCORI’s funding of this project allowed myself and others a vehicle by which we can find more people who are like us and who can go from being unemployed and unemployable to full-time, productive lifestyles.”

We’re pleased to have many supporters of our efforts to improve mental and behavioral healthcare and our particular approach to the research needed to achieve that goal, including organizations like Research!America. That’s one reason why we were excited to cosponsor a recent Capitol Hill briefing with Research!America on the role of patient-centered research in addressing gaps in the treatment of mental illness, especially in minority communities. As Research!America’s Ellie Dehoney notes, society suffers when there are disparities in care, and all of us who care about medical innovation want to ensure everyone benefits.

We at PCORI look forward to a continued partnership with Research!America for years to come, working to support research that will lead to a more patient-centered, efficient, and useful healthcare system for all of us.

Grayson Norquist, MD, MSPH, is Chairperson of the PCORI Board of Governors, Vice-Chair of the Emory University Department of Psychiatry and Behavioral Sciences, and Chief of Psychiatry Service at Grady Health System in Atlanta.

Joe V. Selby, MD, MPH, is PCORI’s Executive Director.

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You can change the image of things to come. But you can’t do it sitting on your hands … The science community should reach out to Congress and build bridges.
The Honorable John E. Porter