Increasing Measurement-Based Assessment and Care for People with Serious Mental Illness

Approximately one in 25 U.S. adults experiences a serious mental illness (SMI) each year. Many people with SMI take antipsychotic medications as a necessary part of their treatment. However, antipsychotics are associated with various adverse effects and medication-induced disorders. Tardive dyskinesia (TD) is one such disorder, characterized by uncontrollable and repetitive movements of the face, neck, arms and legs. Screening and routine monitoring for medication-induced disorders coupled with the use of antipsychotic medications greatly improves treatment outcomes for these patients.

Measurement-based care (MBC) is an important strategy to facilitate early screening, early intervention, mitigation of medication adverse effects and improved overall mental health outcomes for people with TD. In the case of TD, MBC provides an effective mechanism to detect early symptoms and develop and monitor a treatment plan, but it is only practiced by a fraction of mental health clinicians.

We must better understand both the barriers and facilitators to the adoption of MBC to increase its adoption in the treatment of TD and mental illness more broadly. With financial support from Neurocrine Biosciences, Inc., a neuroscience-focused biopharmaceutical company, the Meadows Institute developed a policy brief drawing on the existing literature and key informant interviews to identify barriers and facilitators and offer relevant policy recommendations.

Key Findings include:

• Significant barriers in electronic health systems to enable data integration and real-time and informed decision-making limit the ability to use MBC to optimize and coordinate care.
• While the value of implementing MBC is clear, its use can lead to increased time, effort and cost, making appropriate incorporation into clinical workflows, clear protocols and careful change management key.
• There are insufficient reimbursement and financial incentives to encourage clinicians and health systems to invest in MBC.
• Lack of health insurance, cost of care, mistrust of the mental health system, discrimination, stigma, limited services and lack of symptom awareness contribute to significant disparities in access to care for people with SMI.

Recommendations:

1. Federal lawmakers should increase funding for IT infrastructure to include behavioral health.
2. Mental health system leaders should invest in EHRs to optimize data collection and utilization.
3. Health systems and clinical teams should integrate MBC into clinical workflows.
4. Health systems should support behavioral health integration and/or coordination between specialty and primary care clinics.
5. Health systems and clinical teams should utilize evaluation and management time or complexity codes to enable adequate compensation for time spent on MBC.
6. The U.S. Preventive Services Task Force should declare TD screening and monitoring as a preventive service with a grade A or B recommendation for anyone taking anti-psychotic medications.
7. Public and private payors should provide adequate reimbursement for MBC and develop value-based care contracts for MBC.
8. Federal and state lawmakers should support flexible telehealth policy
9. Clinical teams, professional associations and advocacy organizations should educate patients, families and community organizations on TD.
10. Providers should work to increase patient trust and engagement.