Behavioral Health

More than one in five U.S. adults live with a mental health or substance use condition. Effective treatments for these conditions exist, but about half of Americans with a mental illness and three-quarters of those in need of help for substance use do not get treatment. Mental health and substance use conditions also affect entire communities: More than 40% of Americans know someone who died of a drug overdose.

Researchers at RAND Health bring a multidisciplinary, systems-based approach to studying behavioral health care. Research teams integrate the expertise of mental health clinicians, policy researchers, economists, social scientists, and statisticians to offer recommendations for transforming the U.S. mental health care system, including intervention development to improve mental health and advance innovative tools to tackle the opioid epidemic.

Expanding Care to Community-Based Settings

Training non-clinicians to deliver initial care expands the mental health care workforce and facilitates delivery in community-based settings. RAND evaluated several innovative programs that trained and empowered lay people:

• A program in New York City more than 155,000 New Yorkers trained in city agency workplaces and community-based settings to use Mental Health First Aid (MHFA) with people experiencing mental illness and encourage them to get help. Most of them were still using what they had learned five years later.
• Also in New York City, the Connections to Care (C2C) collaborative delivered mental health screening and evidence-based interventions through staff at community-based organizations serving at-risk populations.
• In California, the National Alliance on Mental Illness and the Diocese of San Bernardino delivered a parish-based intervention to reduce stigma, increase mental health literacy, and improve access to mental health services.

Connecting People to Treatment

Individuals with opioid use disorder (OUD) often have co-occurring mental health disorders, such as depression, bipolar disorders, or schizophrenia. The U.S. health care system, however, tends to treat substance use and mental health disorders separately.

Clinical trials: RAND has been building on its previous model of collaborative care, SUMMIT, in efforts to deliver OUD treatment where patients may already be seeking care.

• CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) worked with practitioners and community health workers to deliver collaborative care. RAND and the University of New Mexico conducted a clinical trial to test whether patients who have opioid use disorder and a mental health condition respond better to integrated treatment delivered in a primary care setting. The five-year study results are pending.
• START-ACS uses knowledge about patients with OUD in a new intervention that uses a hospital-based consultation service to initiate medication treatment for OUD in the hospital and connect patients to follow-up care in the community. Initial results show that people receiving treatment through this service were twice as likely to begin medication treatment in the hospital and significantly more likely to find care in the community after discharge.

Evaluating California's Statewide Initiatives

The California Mental Health Services Authority (CalMHSA), a coalition of county-based behavioral health systems, has used its unique position to improve delivery of mental health care in communities across the state of California since 2009.

A long-time evaluation partner: RAND has worked with CalMHSA for more than ten years to assess implementation and outcomes of a wide range of prevention and early intervention programs:

• RAND researchers are helping program partners measure their progress toward meeting statewide objectives, assess the activities that they have implemented and the resources they have created, and evaluate overall program outcomes.
• A recent study developed a new framework to estimate psychiatric bed capacity in multiple California counties and statewide, which policymakers can use to inform resource allocation.
• RAND has also conducted evaluations for specific California counties. For instance, they have evaluated Los Angeles County’s mental health community engagement campaigns.

Evaluating Certified Community Behavioral Health Clinics

The Certified Community Mental Health Clinic (CCBHC) demonstration project is a national effort to address chronic fragmentation, underfunding, and inadequate capacity of behavioral health services in the United States. CCBHCs offer a “no-wrong-door” approach by serving anyone who requests care for mental health or substance use conditions, regardless of their ability to pay, place of residence, or age.

Monitoring impact, shaping implementation: RAND, in collaboration with Mathematica Policy Research, has been evaluating CCBHCs as they evolve. Medicaid funded the first CCBHCs in 2017, with 67 clinics operating across eight states. Based in part on evaluation results, Congress has extended the demonstration, most recently expanding it to all states and territories.