CHILDREN AND FAMILIES The RAND Corporation is a nonprofit institution that helps improve policy and EDUCATION AND THE ARTS decisionmaking through research and analysis. ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE This electronic document was made available from www.rand.org as a public INFRASTRUCTURE AND service of the RAND Corporation. TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS NATIONAL SECURITY Skip all front matter: Jump to Page 16 POPULATION AND AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY Support RAND TERRORISM AND Browse Reports & Bookstore HOMELAND SECURITY Make a charitable contribution For More Information Visit RAND at www.rand.org Explore RAND Europe View document details Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND Web site is prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity. EUROPE Mental Health Retrosight Perspectives Alexandra Pollitt, Stephanie Diepeveen, Susan Guthrie, Marcela Horvitz-Lennon, Molly Morgan Jones, Siobhán Ní Chonaill, Dana Schultz, Harold Alan Pincus, Jonathan Grant, Steven Wooding EUROPE Mental Health Retrosight Perspectives Alexandra Pollitt, Stephanie Diepeveen, Susan Guthrie, Marcela Horvitz-Lennon, Molly Morgan Jones, Siobhán Ní Chonaill, Dana Schultz, Harold Alan Pincus, Jonathan Grant, Steven Wooding Prepared for the Alliance of Mental Health Research Funders The project described in this report was supported in Canada by the Graham Boeckh Foundation, Alberta Innovates Health Solutions, and the Canadian Institutes of Health Research; in the UK by the National Institute for Health Research; and in the USA by the National Institute of Mental Health. RAND Europe is an independent, not-for-profit policy research organisation that aims to improve policy and decisionmaking for the public interest though research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark © Copyright 2013 RAND Corporation Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial pur- poses. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND documents are protected under copyright law. For informa- tion on reprint and linking permissions, please visit the RAND permissions page (www.rand.org/publications/permissions.html). RAND OFFICES SANTA MONICA, CA • WASHINGTON, DC PITTSBURGH, PA • NEW ORLEANS, LA • JACKSON, MS • BOSTON, MA DOHA, QA • CAMBRIDGE, UK • BRUSSELS, BE www.rand.org • www.rand.org/randeurope Preface Mental Health Retrosight was a three-year international project that aimed to investigate the translation and payback from mental health and neuroscience research, with a particular focus on schizophrenia. It looked at the development of research over a 20-year period in Canada, the USA and the UK. The project was supported in Canada by the Graham Boeckh Foundation, Alberta Innovates – Health Solutions, and the Canadian Institutes of Health Research; in the UK by the National Institute for Health Research; and in the USA by the National Institute of Mental Health. It was the first project funded through the Alliance of Mental Health Research Funders, a joint initiative between the Graham Boeckh Foundation and RAND Europe. The network was established as a ‘think tank without borders’ that would undertake research and analysis into mental health research funding. This report presents the full set of backward-tracing perspectives. This is intended to complement the other reports associated with this study, which describe the findings and policy provocations, the methods and methodology, and the forward-tracing case studies. RAND Europe is an independent not-for-profit policy research organisation that aims to improve policy and decision making in the public interest, through research and analysis. RAND Europe’s clients include European governments, institutions, NGOs and firms with a need for rigorous, independent, multidisciplinary analysis. This memo has been subject to RAND’s quality assurance process, but as an interim report on work in progress has not undergone full peer review. For more information about RAND Europe or this document, please contact: Alexandra Pollitt RAND Europe Westbrook Centre Milton Road Cambridge CB4 1YG United Kingdom Tel. +44 (1223) 353 329 [email protected] i Contents Preface .......................................................................................................................... i Acknowledgements ....................................................................................................... v CHAPTER 1 Introduction ........................................................................................... 1 CHAPTER 2 Supported employment .......................................................................... 3 CHAPTER 3 Cognitive behavioural therapy .............................................................. 39 CHAPTER 4 Early intervention for schizophrenia ..................................................... 59 CHAPTER 5 Clozapine.............................................................................................. 95 CHAPTER 6 Addressing the metabolic side effects of second-generation antipsychotics ..................................................................................... 127 CHAPTER 7 Cognitive-enhancing drugs ................................................................. 165 iii Acknowledgements We would like to acknowledge all the researchers and practitioners who were willing to act as the participants for this study, particularly those interviewed for the backward-tracing perspectives. The study would clearly have been impossible without them. We would also like to thank our quality assurance reviewers, Saba Hinrichs and Sarah Ball, who provided thoughtful, constructive and timely comments. v CHAPTER 1 Introduction This report presents the story of the development of six interventions aimed at improving mental health care. These narratives were assembled as part of Mental Health Retrosight, an international project which examined the attributes of research that lead to successful translation into patient benefit. We identified the six interventions through a combination of a survey, a comparison of clinical guidelines over time and across the three countries of the study (Canada, the UK and the US) and the input of our subject expert advisors. Having selected the interventions, we then tried to develop narratives for each through a combination of telephone and face-to-face interviews, reviews of archived material and literature reviews. As we developed these, it became clear that the scope of the subjects covered and the contested nature of the fields meant it was not feasible to construct a single, definitive narrative for each intervention. Instead we concentrated on consulting a variety of sources and establishing a balanced perspective. This is why we choose to refer to these narratives as ‘perspectives’ rather than histories or case studies, as they represent one perspective on the developments, albeit one drawn from a reasonably wide variety of diverse sources. The six interventions we examined were: The use of cognitive behavioural therapy, a form of psychosocial or ‘talking’ therapy, as a treatment for schizophrenia. The recognition of the value of early intervention in schizophrenia and the realisation that treatment was often delayed. The use of supported employment as a way to help people with schizophrenia gain and maintain employment. The development, introduction, removal and re-introduction of clozapine, the first of the second generation anti-psychotic drugs. The recognition of, and moves to address, the metabolic side effects of second generation antipsychotics. The recognition of the role of cognitive deficits in schizophrenia, and efforts to develop cognitive-enhancing drugs to address them. The analysis was iterative and took a narrative approach. A researcher who had not been involved in assembling the perspectives read and reviewed the full set, extracting and 1 Mental Health Retrosight RAND Europe describing the attributes that appeared to have either promoted or hindered translation. Further details of the selection and construction of the narratives are provided in the Methods and Methodology Report.1 We are publishing the perspectives to increase the transparency of our research process. We hope the publication will allow other researchers to build on our work, through adding further cases or refining existing ones. During the project we refined and developed the methods and structuring of the cases, learning from some cases in conducting others. However, it