Feds freeze mental health practices registry

Established in 1997, the National Registry of Evidence-based Programs and Practices was overseen by the Substance Abuse and Mental Health Services Administration, under the US Department of Health and Human Services.

In order to be listed on the registry, programs had to undergo a review process by the administration to determine the regimen's effectiveness.

The registry had been managed by Development Services Group Inc., an outside organization that specializes in assessing behavioral health programs and contracted by the mental health services administration. Participants of the registry were sent an email notifying them of the suspension.

The email reads, "It is with great regret that we write to inform you that on December 28, 2017, we received notification from SAMHSA that the NREPP contract is being terminated for the convenience of the government.

"We are deeply saddened by the government's sudden decision to end the NREPP contract," the letter said, requesting that all comments and concerns be directed to the mental health services administration.

A statement posted on the program's website this week says that "Although the current NREPP contract has been discontinued, SAMHSA is very focused on the development and implementation of evidence-based programs in communities across the nation. SAMHSA's Policy Lab will lead the effort to reconfigure its approach to identifying and disseminating evidence-based practice and programs."

A new approach

The Policy Lab is a program funded through the 21st Century Cures Act, which was signed by President Barack Obama in December 2016. The lab aims to "promote evidenced-based practices and service delivery models through implementation grants and evaluation" by building on existing resources like the registry.

Neither the Substance Abuse and Mental Health Services Administration nor Health and Human Services responded to requests for comment.

Mental health services administration spokesman Brian Dominguez told the Washington Post that a new group was taking over the registry's duties and would work closely with other parts of the agency to "institute an even more scientifically rigorous approach to better inform the identification and implementation of evidence-based programs and practices."

Officials told the Post that the registry will remain online but would not be updated. The last updates were made in September.

They also gave no reason as to why the program was suspended or any specifics as to when the new approach will be officially launched and its findings made public.

'It came with such a blinding speed'

The move took mental health advocates by surprise. "It came with such a blinding speed," said Richard Yep, CEO of the American Counseling Association. "People were initially really shocked by the whole thing,"

The registry has been a go-to tool for many members of the association, he said, helping counselors "move services faster to those who are most in need."

Former Rhode Island Rep. Patrick Kennedy, who also sat on President Trump's opioid commission, said the move was devastating, particularly in light of the opioid epidemic and rising suicide rates.

"Evidence-based interventions and treatments are absolutely critical to recovery. The federal government is abdicating its duty to make sure that individuals with mental illness and substance use disorder receive cutting-edge treatment," Kennedy said.

Critics of the program have questioned the registry's effectiveness. A recent paper in the International Journal of Drug Policy found that it contained programs with limited studies evaluating them or studies with very small sample sizes to determine success.

Yep admits that the program wasn't flawless but said "it has stood the test of time." He questioned why a replacement wasn't up and running to take over the work and called the decision to freeze the registry short-sighted. "Why didn't you start that system up and compare it side-by-side? Instead, to just cut it off, it makes no sense professionally."

Lawmakers express concern

Lawmakers are also concerned. Republican Sen. Rob Portman of Ohio has been deeply involved in legislative efforts to combat the opioid epidemic. According to the US Centers for Disease Control and Prevention, his state has the second-highest rate of fatal overdoses in the country.

Upon learning about the freezing of the registry, Portman said, "I'm concerned and looking into it. I've long believed we must use federal funds for evidence-based programs that work, and we must continue to make this a priority."

Rep. Grace Meng, a New York Democrat who sits on the House Committee on Appropriations, praised the registry on Friday in a letter to Dr. Elinore F. McCance-Katz, the nation's first Health and Human Services assistant secretary for mental health and substance use. Meng called the registry and its website "crucial public health tools."

She drafted a followup letter on Monday to McCance-Katz, questioning the contract termination. "I was shocked to read online that the NREPP contract has been terminated for the 'convenience of the government,' " she wrote, and further questioned the rationale involved in the decision-making process.