NRI highlights the lead article from the newsletter below.
First Episode Psychosis Set Aside Rises from 5% to 10% and Study Published Demonstrating the Cost Effectiveness of RAISE NAVIGATE
In 2014, Congress approved a 5% addition to the Mental Health Block Grant (MHBG) program that was set aside for states to use for the planning and implementation of treatment programs for first episode psychosis (FEP). In December of last year, Congress approved an increase of the set aside to 10%. This is an increase in MHBG funding dedicated to FEP from $25 million – $50 million. However, since the set aside amount is determined as a percentage of the current MHBG funds each state receives, some states receive far fewer funds than other states, and may not receive enough to start a complete FEP treatment program from scratch without additional financial commitment from the state.
The initial 5% set aside required all states, including those states with no existing FEP treatment programs, to come up to speed quickly with current treatment best practices. One of these best practices is coordinated specialty care (CSC), of which RAISE (Recovery after an Initial Episode of Psychosis) and its programmatic children, OnTrack and NAVIGATE, are the most widely spread examples. Some states, such as New York (OnTrack) and Oregon (EASA) have become national leaders in FEP treatment and now provide such treatment throughout their states. Other states, particularly those states receiving fewer set aside funds, have opted to implement individual EBPs targeting FEP, or training for staff about best practices for treating FEP.
As part of a SAMHSA contract with JBS International and NASMHPD, NRI completed An Inventory & Environmental Scan of Evidence-Based Practices for Treating Persons in Early Stages of Serious Mental Disorders, which catalogues and examines existing FEP treatment program models, as well as a Snapshot of SMHA Plans for Using the Five Percent Set-Aside for Early Intervention Programs, which records the activities of each state in response to the 5% set aside. In the coming months, NRI will update the snapshot to include changes in state activity due to the expansion of the set aside to 10%. To do this, NRI will use the revisions to the MHBG Plan that each state had to submit in early 2016 after the expansion of the set aside to 10%. NRI will then follow up with each state to ensure that the Snapshot accurately reflects the activities of each state.
This January, Dr. Robert Rosenheck, of the Yale School of Medicine, and colleagues released a study of the cost effectiveness of the NAVIGATE variant of the multi-state RAISE study. They used a standard deviation change in the Quality of Life Scale to measure and compare the effectiveness of NAVIGATE and “usual community care” for individuals experiencing a first episode psychosis. The study showed that improvement to quality of life was more expensive with NAVIGATE. However, as the study concluded, “the value of the achieved clinical benefit appears to justify these additional expenditures…” This study was showcased this March during a NASMHPD/NRI-sponsored webinar, “Team-based Treatment for First Episode Psychosis is Cost Effective: Implications for Policy and Practice.”
States are currently pursuing plans to expand FEP treatment to new sites using the 10% set aside. Many states are working toward finding other funding sources for FEP treatment programs to ensure funding sustainability. Starting in FY 2017, SAMHSA will begin evaluating the effectiveness of FEP treatment.