Recovering the Momentum for Federal Support of Multisite Demonstrations

To the Editor: The October issue of Psychiatric Services, with its remarkable array of articles summarizing the results of multisite research demonstration studies, gives the reader cause for thought, reflection, and perhaps outrage. The history of mental health treatment is replete with examples of well-intentioned interventions, developed and perpetuated on the basis of nothing more than a potentially innovative concept, a desperate patient and provider population, a charismatic proponent, and little, if any, evidence. The studies in the October issue demonstrate that improvement in mental health service delivery can be based on firm scientific evidence that moves us beyond anecdote mixed with enthusiasm.

What better use for sadly limited federal funds than to enhance the quality of care through carefully crafted, scientifically sound, multisite studies of clinically relevant service interventions? The results have an impact on services and policy decisions throughout the nation—if not the entire globe—and bring us closer to the goal of evidence-based practice. The findings can support the efforts of consumer advocates to ensure financial resources for effective services through private insurance coverage, public Medicare and Medicaid reimbursement, and direct financing from state mental health departments.

In the face of budgetary pressures and outright cutbacks, states and local communities will inevitably seek additional funding for direct service support. Tempting as it is to respond with reprogramming of funds and reduction or elimination of knowledge enhancement efforts, there can be no more foolish and shortsighted a decision. And yet, as Sharfstein (1) points out in his commentary in the October issue, this is exactly what has happened. We have lost the momentum represented in the articles by Leff, Domino, Morrisey, Noether, and their colleagues. Rather than careful examination of clinical and psychosocial services to generate knowledge that could benefit all, we are applying a deceptively soothing balm in providing some service enhancements for a few lucky recipients in the lottery of federal funding distributions.

Hopefully the time will soon come when a carefully crafted, well-planned, and deliberate use of federal support to enhance the quality of mental health treatment through the study of the implementation of efficacious interventions in real-world settings will once again guide our national efforts.

Dr. Arons is executive director and chief executive officer of National Development and Research Institutes, Inc., in New York City. From 1993 to 2002 he was director of the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.