Current Trends in Treatment Research and Practice

This chapter discusses current trends in psychosocial treatment research and clinical practice. The chapter highlights four active areas in which intervention research and practice are changing: efforts to disseminate evidence-based psychosocial interventions, to integrate physical and mental health care services, to develop treatments (transtreatments) that can be used to treat multiple disorders, and to exploit the range of new technologies available (e.g., Internet, apps) as a way of providing interventions. These areas of research are among those most relevant to the goals of this book, namely, providing interventions in ways that can reduce the burdens of mental illness.

Scope and Burdens of Psychological Dysfunction

This chapter addresses several key background topics, including the range and types of psychological dysfunctions, the scope of the problems in terms of incidence and prevalence of cases, and the burdens these place on individuals, families, and society at large. The chapter conveys core features of the mental health crisis and why innovation in developing remedies is so critical. The aim of the chapter is to establish the need for more effective interventions in light of the range of dysfunctions, the high number of people who experience them, and the burdens these dysfunctions cause. The burdens can be evaluated in many ways, including measures of impairment, costs, disability, and lost days. Overall, the costs and lost days of adequate functioning and lost days of life are enormous as a result of mental illness.

Need to Expand Interventions and Models of Intervention Delivery

This chapter clarifies the distinction between psychosocial interventions (what is done to change clinical problems) and the way in which the interventions are presented or provided (models of delivery). The dominant model of psychosocial treatment delivery, which involves in-person, one-to-one therapy with a mental health professional in a special setting, is discussed, along with inherent limitations in reaching large numbers of people in need of services. The chapter presents characteristics that would be needed in a model of delivery to overcome these limitations. These characteristics include scalability, reach, affordability, expansion of the nonprofessional workforce, expansion of settings where interventions are provided, feasibility, flexibility, and acceptability of the model of delivery.

Conceptualizing the Challenge and Moving to Solutions

This chapter places the challenge of reducing the burdens of mental illness in broader contexts and progresses from these to concrete recommendations on how to proceed toward next steps. The notions of wicked problems and grand challenges provide two contexts for understanding the challenge. From broad concepts, the chapter moves to means of addressing challenges and making progress in concrete ways to reduce the burdents of mental illness. Illustrations are provided of promising efforts in relation to physical health, mental disorders, and substance use and abuse. The critical role of assessment, especially large-scale surveillance measures from public health, is also discussed.

Expanding Our Perspectives on Interventions, Models of Delivery, and Clinical Care

This chapter considers topics that can assist in reducing the burdens of mental illness beyond the novel models of delivery discussed previously. The topics include the utility of expanding our interventions to include “weak” interventions that are low cost but highly scalable, providing special attention to those whose burdens are particularly great, promoting interventions that can affect both physical and mental health, targeting transmechanisms and early pathways leading to multiple disorders, and improving the base level of health in society. Stepped care is discussed in relation to sequencing interventions as well as models of delivery.

Novel Models of Delivery 2

This chapter builds on the prior chapter with an additional set of models that can deliver psychosocial interventions and reach many people in need of services. The chapter covers six models: best-buy interventions, lifestyle changes, use of social media, entertainment-education, socially assistive robotics, and social network interventions. The chapter author describes the models, provides examples, and explains how they complement and improve on the dominant model of psychotherapy as a way of reaching people in need of services. Also emphasized is the importance of having multiple models to deliver psychosocial interventions.

Introduction

This chapter conveys the overall challenges in relation to mental disorders and their care. The challenges are the enormous need for effective clinical services and our current inability to provide them. The chapter breaks down the scope of mental illness and the paucity of treatment services into parts to convey the size of the problem and challenges, and states that the purpose of the book is to examine what can be done to reduce the personal and social burdens of mental illness. The chapter provides an overview of the focus of the book and sets the stage for elaborating the challenges and novel options to address them, noting that well above and beyond psychotherapy, there are other remarkable opportunities for helping people to overcome impairing conditions, as well as to improve life.

Evidence-Based Psychosocial Interventions

This chapter discusses the development of psychosocial interventions with supportive evidence in their behalf. The goals of these evidence-based psychosocial interventions are to reduce psychological dysfunction related to affect, cognition, and behavior and psychiatric disorders that can impair everyday functioning. The range of treatments with an evidence base is vast and includes multiple cognitive and behavioral treatments, traditional therapies, and many “treatments as usual.” This chapter provides a description of the current status of treatment, as well as the challenges related to interpretation of findings and the generality of findings from research to practice.

Closing Comments

This chapter brings together much of the content in the way of key questions to guide us and to provide steps needed to address the challenges of reducing the burdens of mental illness. Key elements needed to have an impact on the burdens of mental illness already are readily available. How to move forward to implement change is a key focus of the chapter. Parallels are drawn with other areas of health that share similar challenges as those related to mental illness. Together, multiple areas suggest the need to change health care broadly. Novel models of treatment delivery can greatly improve access to treatment but more will be need to maximize the broadest and most enduring impact.

Novel Models of Delivery 1

This chapter presents models of delivery that complement and build on the dominant model of psychotherapy. The proposed models deliver available treatments but in novel ways. The models address key characteristics that will be required if interventions are to reach people in need of services. The models discussed in this chapter are task shifting and sharing, disruptive innovations, and delivering interventions in unconventional (everyday) settings. The chapter conveys that that to scale treatment to help large numbers and to reach special populations in need will require multiple models.