NIH Invests in Projects Aimed at Improving Treatment of Psychosis, OUD

At last month’s IPS: The Mental Health Services Conference, leaders from NIH were on hand to discuss the latest research projects in their portfolios that might impact community psychiatrists.

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The panel included Patricia Powell, Ph.D., deputy director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA); Carlos Blanco, M.D., Ph.D., director of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse (NIDA); and Robert Heinssen, Ph.D., the director of the Division of Services and Intervention Research at the National Institute of Mental Health (NIMH).

One of the ambitious projects discussed by Heinssen was a multistate clinical trial aiming to evaluate a “learning health system” in the treatment of early psychosis. A learning health system is a dynamic approach to health care in which clinical data collected from patients as well as new research findings are continually evaluated to see which approaches are proving effective and which might not be working as intended; these changes are then immediately implemented into clinical practice. The goal of a learning heath system is to always be on the cusp of the latest evidence to ensure patients are receiving optimal care.

Heinssen said the new study will include 58 coordinated specialty care programs across nine states that are part of NIMH’s Early Psychosis Intervention Network (EPINET). Through EPINET, coordinated specialty care programs are linked to each other via a coordinating research center that serves as a regional hub. This hub consolidates patient data from the individual programs to enable data sharing and improve communication between them. The participating programs are divided among five regional EPINET hubs and include programs both rural and urban, large and small.

Each EPINET regional hub will have a specific research focus, Heinssen said. These projects will test whether a learning health system can reduce delays in access to care, prevent suicide, improve cognitive functioning, improve treatment adherence, and sustain patient gains in the long term for patients recently diagnosed with psychosis.

About 2,500 patients are enrolled, which is half the hoped-for goal of 5,000 enrollees.

The new EPINET initiative was not the only effort aimed at improving community-level care discussed at this session. As part of the NIH HEAL Initiative, NIMH and NIDA recently funded four multisite trials that will test the effectiveness of collaborative care for treating people with opioid use disorder (OUD) in a primary care setting. Specifically, the projects will test whether a triple-integrated model (substance use care, mental health care, and primary care) is more effective than usual care and/or collaborative care alone at improving clinical outcomes in patients with both OUD and other mental illnesses. The projects will also assess the costs of incorporating OUD care into a collaborative model to see whether such care is cost-effective and sustainable over time.

Blanco also discussed NIDA’s recently established Justice Community Opioid Innovation Network (JCOIN). This multifaceted project (also part of NIH HEAL) will fund 10 research institutions across the country to study ways to improve the delivery of OUD treatment in such settings as jails, prisons, and drug courts. The project aims to improve access to medication treatment at these settings and evaluate whether strategies such as peer support or telepsychiatry can retain people in OUD treatment as they navigate through the justice system. ■