Mental Health Treatment

This video was recorded at RAND's 2012 Politics Aside event.

Ret. Gen. Peter Chiarelli, who was Army vice chief of staff and now is CEO of One Mind for Research, explains why he disagrees with the idea that the post-traumatic stress soldiers suffer is a disorder. He spoke with RAND Corporation President and CEO Michael Rich at RAND's Politics Aside conference in Santa Monica, Calif.

In the coming weeks and months, we will hear numerous calls for better mental health programs and policies as a way to prevent tragedies such as the Newtown, Conn., shooting. As news and details trickle out, we may or may not emerge with a complete picture of what led Adam Lanza to take his anger out on his mother and 26 innocent lives.

The latest reports paint a picture of a mother struggling to care for her troubled adult son. And as many families can attest, the challenges of caring for a young or adult child with severe mental illness or emotional or behavioral disturbance are profound and heartbreaking. In our national conversation on mental health, we should remember the role of families when thinking about mental health treatment and ensure that our policies open up opportunities to support parents, siblings and relatives, and enhance their capacity for care.

I've spent much time since Friday imagining the unimaginable—little children murdered in the place that is supposed to be their home-away-from-home, their elementary school. The media fed my curiosity. I could not stay away from checking the news and blogs hourly, despite my family's pleas to stop reading and my own knowledge that it can be too much to read so many details, see so many pictures, grieve from afar.

It's because I want to help. I am a psychologist, and this is why I went into the profession and made trauma my focus. I know from a vast amount of research that many of those touched by Friday's shootings will experience a great deal of distress in the weeks and months ahead. But they will, somehow, miraculously, find a pathway forward to health and productivity. And I am reassured that over the past 15 years or so, we have developed a wide array of practices, procedures, and interventions that are well-tested and helpful for those children that will take longer to recover.

On June 27 we observe Post-Traumatic Stress Disorder (PTSD) Awareness Day, a day established in 2010 by the U.S. Senate. Policymakers continue to look for ways to best help our nation's servicemembers and veterans with PTSD and other combat related mental health problems.

RAND research has documented the prevalence of post-deployment mental health problems among our newest generation of veterans, examined the delivery of post-deployment mental health care, reviewed the treatment capacity of health care systems in response to PTSD, and estimated the costs of providing quality mental health care to all affected veterans.

Continuing our efforts to support awareness of mental health issues during National Mental Health Month, we turn to how violence and trauma affect children. The impact of violence and trauma on children has led RAND and its partners to focus not only on studying the problem, but working collaboratively to find interventions that help address a significant public health need. Indeed, children's exposure to violence is a significant health issue in the United States. Between 20 percent and 50 percent of children every year are touched by violence, either as victims or, even more commonly, as witnesses. Even more are exposed to natural disasters, accidents, or the traumatic loss of a loved one. The emotional impact may be profound. Children exposed to violence frequently develop post-traumatic stress symptoms. They are more likely to have behavioral problems, poorer school performance, more days of school absence, and feelings of depression and anxiety. Violence affects all racial, ethnic, and economic groups, but its burden falls disproportionately on poor and minority children—the same children whose mental health needs are least likely to be met by the health care system.

School settings can be a promising setting for addressing this gap in the mental health care system. Therefore, a team of clinician-researchers from RAND and several other institutions in the Los Angeles area (UCLA, Los Angeles Unified School District, and USC) collaborated to develop, implement, and evaluate a school-based program designed to help children traumatized by violence.

In recognition of National Mental Health Month, May 2012, we spotlight posttraumatic stress disorder (PTSD) and RAND's work to advance understanding and treatment of this condition, which affects many more people than is commonly thought. Indeed, Mental Health America, the oldest and largest non-profit mental health organization in the United States, is emphasizing traumatic events and their effects as key themes for its Mental Health Month activities this year.

PTSD is an anxiety disorder that can follow from witnessing or directly experiencing an event involving injury, threat to life, or death. People with PTSD may continue to re-experience the traumatic event through flashbacks or nightmares and may feel anxious, numb, or hyperaroused. PTSD can last for years and severely impair day-to-day functioning. The condition exacts an enormous toll on trauma survivors, their families, and society. Moreover, we may be underestimating the individual and societal costs of PTSD, given growing appreciation that PTSD contributes to other chronic and costly physical health problems such as arthritis, diabetes, and cardiovascular disease.

This commentary appeared on Independent Sector on March 21, 2012.

One of my interests is building evaluation capacity within nonprofit community service organizations to increase impact. The model RAND uses for this work is called Getting To Outcomes (GTO), a free program management tool with demonstrated success in improving program performance.

Getting To Outcomes emphasizes Continuous Quality Improvement (CQI), which we define as a planned, structured process with the goal of improving outcomes. We have adapted the Plan-Do-Study-Act (PDSA) cycle approach for use in community service settings, where data and resources to conduct analyses are often limited as compared with settings where PDSA was first developed (e.g., manufacturing) and currently used (e.g., hospitals). Plan-Do-Study-Act allows organizations to pilot small changes and see if these changes enhance service delivery and outcomes. Inherent in this approach is the use of data to analyze a program or process and understand the impact of applying the PDSA cycle. Critical to PDSA are support from leadership and the inclusion of multiple levels of the organization (i.e., a team-based strategy) to plan, design, implement, and study impact. For example, we've found that it is critical for leaders to support a dialogue among program staff about the potential strengths and weaknesses of a particular program and to support and provide resources to staff to make changes. Another important component of CQI is that it is ongoing. That means that it is not a one-time event, but should be incorporated into regular staff meetings for progress monitoring and mid-course adjustments, as well as for celebrating successes and problem solving setbacks.