PERSPECTIVE: A Mental Health Services Research Agenda in the Era of COVID-19: Steadfast Commitment to Addressing Evolving Challenges.

Abstract

Background: Decades of research that predate the COVID-19 pandemic demonstrate that most people with mental health needs are not receiving adequate care. The inequities between those who need care and those who receive adequate care are larger for racial and ethnic minority groups and people living in underserved communities. The pandemic is associated with an exacerbation of these inequities, resulting in increased morbidity and mortality for the most vulnerable populations.

Aims: This Perspective summarizes longstanding and evolving challenges to the provision of high quality care for people with mental illness, describes the National Institute of Mental Health's (NIMH) commitment to addressing those challenges, and embeds salient research priorities most germane to the health policy readership of this journal.

Methods: Example funding announcements and extant funding priorities are highlighted to demonstrate NIMH's commitment to health services research during the pandemic. The collaborative care model is presented as an evidence-supported service delivery model that could be delivered via telehealth. Recent studies that compare the utilization of routine telehealth services during the pandemic, when compared to in-person services pre-pandemic, are summarized.

Results: In FY2020, NIMH invested $171,194,275 in health services research. Over the past two years, NIMH led or participated on dozens of funding announcements that call for mental health services research to help improve the provision of care for people with mental illness. Service delivery models like collaborative care can offer effective intervention via telehealth. The practice community can deliver routine services via telehealth at volumes similar to pre-pandemic in-person levels. However, wide variation in telehealth utilization exists, with inequities associated with racial and ethnic groups and underserved rural locations. A limitation is that clinical outcomes are not routinely available from administrative datasets.

Discussion: There continues to be an urgent need for health policy research and collaboration with the health policy community as part of the research enterprise.

Implications for health care provision and use: NIMH encourages and often requires strong research practice partnerships to help ensure findings will be of value to end users and make their way into the practice setting. There is a need to study pandemic related changes in financing, delivery, receipt, and outcomes of mental health care.

Implications for health policies: Despite robust evidence, clinical practice guideline recommendations, and established financing mechanisms, uptake of service delivery models that can be delivered in part or in full via telehealth (e.g., the collaborative care model) is poor.

Implications for further research: In the era of COVID-19, the charge to the mental health services research community is urgent: (i) develop strategies to better implement, scale, and sustain existing evidence-supported treatments and services and (ii) develop, test, and evaluate new solutions to improve access, continuity, quality, equity, and value of care.