Trump Administration Halts Registry Used by Mental Health Professionals
Updates to a government-run database of evidence-based treatments related to mental health and substance abuse have been halted by the Trump administration. The news was publicized following an email received by the database’s developers on Jan 4.
The National Registry of Evidence-Based Programs and Practices (NREPP) was widely used by doctors, state and local governments and the general public to determine which mental health and substance abuse programs were useful treatments.
Launched in 1997, NREPP lists 453 tested and reviewed interventions and can be tailored based on multiple demographic factors such as ethnicity, location, gender and sexual preference.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is in charge of the registry, which was last updated in September. SAMHSA’s website states that its Policy Lab will work on a new approach to identifying and disseminating evidence-based practices and programs by talking with other institutions within the government such as the National Institutes of Health.
During a conference call Jan. 11, Elinore McCance-Katz, assistant secretary for mental health and substance use, said that NREPP was not a beneficial database, and there was a “complete lack of linkage” between evidence-based practices and actual treatment of mental illness and substance abuse.
In a statement from McCance-Katz, she said that NREPP vetted programs submitted by outside developers, which resulted in treatments that did not meet the full spectrum of needs of people with substance abuse issues and mental illness. These needs include screenings, treatments, psychotherapies, recovery services and more. SAMHSA said it will now identifying evidence-based treatments in-house. McCance-Katz added:
The program as currently configured often produces few to no results, when such common search terms as “medication-assisted treatment” or illnesses such as ”schizophrenia” are entered. There is a complete lack of a linkage between all of the [evidence-based programs] that are necessary to provide effective care and treatment to those living with mental and substance use disorders, as well. If someone with limited knowledge about various mental and substance use disorders were to go to the NREPP website, they could come away thinking that there are virtually no EBPs for opioid use disorder and other major mental disorders – which is completely untrue.
While McCance-Katz expressed that NREPP was flawed, the database was still widely used by mental health and medical professionals, some of whom voiced their concern on Twitter.
Hard to believe this is happening. NREPP has been a valuable resource for mental health professionals. Such freely accessible databases are critical to keep track and search for evidence-based programming. #savenrepp #mentalhealth https://t.co/xu8SmQhNMb
— Maya Boustani (@MayaBoustani) January 6, 2018
Maintaining an up-to-date NREPP is the only ethical option. Allied mental health professionals: we have to refuse to adjust to this.
— Jessica L. Schleider (@JLSchleider) January 6, 2018
So I just got the news that the Trump admin defunded SAMHSA’s NREPP. Teen suicides are up. Yeah, this is a great time to start kicking research in the teeth.
— Jen Wright Berryman (@jenlwberry) January 4, 2018
Always wished that #NREPP had a higher bar for what it calls #EvidenceBased , but would prefer to have it made better, not eliminated. Awaiting full information, confirmation, comment from #SAMHSA https://t.co/WvjqvkLykI
— Valerie King (@drvalking) January 6, 2018
The registry is still available online but has not been updated since September. Christopher Jones, director of SAMHSA’s mental health and substance use policy laboratory, said it will probably be available until a new system is in place. What the new system will be, as well as the timeline for getting it up, is unclear.
On Wednesday, a handful of U.S. senators sent a letter of concern to McCance-Katz in response to the discontinuation of NREPP. They wrote:
We understand that the Policy Lab is going to ‘play a central role in shaping SAMHSA’s efforts to bring more science to the evidence-based practices used in the prevention, treatment, and support services being provided by behavioral health practitioners and other clinicians’; however, it is unclear when the Policy Lab will be ready as a resource and what resources it will include for behavioral health practitioners.
Under the 21st Century Cures Act, the Policy Lab was supposed to be up and running by Jan. 1. No announcements have been made as to when the Policy Lab will provide resources to health professionals, the senators wrote, adding that the lab is not fully staffed.
“Given that NREPP was discontinued before the Policy Lab was fully implemented, this is especially concerning for behavioral health professionals who rely on up-to-date data from NREPP as a resource for their daily work,” the letter stated.
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