Mental Health Policy Research

Mental Health Research

Overview
“It is becoming clear that the mental health services system does not adequately serve millions of people who need care. … The system is fragmented and in disarray¾not from lack of commitment and skill of those who deliver care, but from underlying structural, financing, and organizational problems... The system’s failings lead to unnecessary and costly disability, homelessness, school failure, and incarceration.”
President’s New Freedom Commission on Mental Health
October, 2002

The Challenge
Caring for those with serious mental illness is a pressing problem in American society.  Five to seven percent of adults suffer from serious mental illness, and about five to nine percent of children have serious emotional disturbances.  Although effective treatments exist for most mental health disorders, many individuals with mental illness receive inadequate or no care.  A recent study found that patients treated for clinical depression received recommended care only 58% of the time.  Moreover, only a quarter of the studies assessing the quality of care for mental health reported adequate rates of adherence to clinical practice guidelines.  These deficiencies are not without consequences.  A recent World Health Organization report ranked depression as the largest contributor to disability in the United States.  Moreover, indirect costs of mental illness due to lost productivity are estimated to be $44 billion annually in the U.S.  Improving the mental health services delivery system promises to advance public health and ease a significant economic burden   

Our Response
Through collaborative research and educational initiatives, we will strengthen efforts by government, private employers, and community leaders to improve the delivery of mental health care.  Our research is intended to inform practices, both clinical and policy-related, that will reduce the personal and societal toll of mental illness in the United States.

What We Hope to Achieve
National initiatives have identified three key obstacles to providing high quality mental health care -- financing inequities, delivery system fragmentation, and stigma.  At Yale, we are pursuing research aimed at addressing all three.  Our goal is to effectively disseminate research findings to key public and private sector decision makers to improve both clinical practice and policy outcomes.  We integrate Yale students in these collaborations with the explicit goal of increasing the number of researchers, policy analysts, and administrators with expertise in mental health policy and with a commitment to promoting evidence-based care. 

We conduct research designed to inform policy and promote change. Examples include:

Understanding the economic consequences of mental health disorders in children

  • Having a child with a mental health disorder results in significant economic hardship on families, including high out-of-pocket spending and reduced parent work hours.

When children do not receive adequate care for their mental health disorders, this may also have long term economic and educational consequences.  Our research has shown that girls with mental disorders have lower educational attainment than their peers.  Better understanding the burden of mental disorders on families is crucial to designing more effective public support programs.

Evaluating insurance expansions for mental health services

  • Private health insurance covers mental health care at a significantly lower level than coverage for physical health conditions. Differential insurance increases the financial burden of treating a mental health problem and creates barriers to access.  Laws requiring equitable insurance for mental health services can be effective.  Our research has shown that these policies are not expensive to implement, can significantly reduce the financial burden of seeking mental health care, and may improve access to care, particularly for low income families.

Examining the long term consequences of mental illness

  • Very little research has been able to document the life course consequences of mental illness to understand both the mechanisms of the impact and the potential value of additional medical treatment during childhood and adolescence.  Our research follows sibling pairs as they age though childhood, adolescence, and young adulthood.  Our findings have shown that poor mental health during childhood and adolescence, such as relatively common disorders including ADHD and depression, are associated with significant reductions in educational attainment (high school dropout, college enrollment), lower levels of labor market attachment, and lower wages in adulthood. 

Examining  black-white differences in the association between depressive symptoms and indices of cardiovascular disease

  • Depressive symptoms have been linked to cardiovascular risk factors and outcomes in both clinic and community-based samples. There is some evidence that these associations are stronger in African-Americans as compared to Whites.  Our work has documented stronger associations between depressive symptoms and indices of cardiovascular disease (aortic calcification, heart disease mortality, stroke mortality) in African-Americans as compared to Whites.

Partnership for Change
The Yale Mental Health Policy Research Group brings together partners at the Yale School of Public Health, the School of Medicine, the Yale Child Study Center, and the West Haven Veterans Administration. We are building links with the broader community and with decision makers at the state and federal level. With this new initiative, we plan to:

  • Conduct peer-reviewed research: We will address policy-relevant questions through cross-disciplinary research efforts and the use of methodologically rigorous approaches
  • Disseminate research findings: We plan to expand our efforts to disseminate our research to policymakers by obtaining new funding support
  • Organize expert forums: We hope to bring mental health policy leaders to Yale to support mutual learning and future research collaborations
  • Enhance the teaching curriculum: We intend to strengthen the curriculum at Yale for undergraduate and graduate students with an interest in mental health policy.  These efforts include developing a mental health policy course and providing summer internships

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