DHS news release

Oregon leading the nation in adding rigor to treatment practices

This guest opinion is by Bob Nikkel, administrator of the Office of Mental Health and Addiction Services in the Oregon Department of Human Services.

Length: 500 words

If you were diagnosed with an illness, you wouldn't want your doctor to show you a random array of folk remedies and say, "Let's try some of these to see if they work…"

You would expect your physician's decisions to be guided by science.

Similarly, Oregon legislators have said much the same thing to the Oregon Department of Human Services (DHS) and four other state agencies that fund mental-health and addictions services.

"Make sure research shows that what the state is paying for works," they told us. Lawmakers want to reduce demands on the criminal-justice system and emergency mental-health services.

As a result, Oregon is at the forefront of states in asking providers of mental health and addiction-treatment services to use research-supported "evidence-based practices."

This will benefit not only tens of thousands of Oregonians receiving treatment, but it should also control other costs. People for whom treatment works will be less likely to be unemployed, go to the emergency room, abuse their kids or get sent to jail or prison.

An example: Therapists treating people with drug problems have often employed an abrupt, confrontational approach, "You have a problem and you need to face up to it." As a result, some clients may quit treatment because they are angry with their therapist or resentful of the approach.

A newer research-tested technique, called motivational interviewing, works with people at their own pace to recognize the problem and sow the seeds of recovery. Research shows that these people stay in treatment longer, complete treatment more often, and are more likely to remember what they've learned because they were partners with the therapist.

But a skeptic might ask, "Why hasn't the state always paid for research-supported treatment?" The answer is it has, although now the expectations have increased. In the future we will see less use of approaches that don't clearly demonstrate good outcomes and more use of those whose effectiveness has passed rigorous review.

Legislators required five state agencies to show that 25 percent of state spending pays for research-supported treatment now, and that 75 percent will do so by mid-2009. The state agencies are DHS, Corrections, and the Oregon Youth Authority, the Commission on Children and Families and the Criminal Justice Commission. You can find more than 125 practices that DHS has approved, based on the review of a professional panel and independent doctoral-level reviewers,  on the agency Web site.

This work will also benefit private-pay clients, and it should reduce burnout of clinicians who may be energized by seeing better results. Other states are contacting Oregon to learn more about what we're doing, and the federal government has begun an initiative of its own.

We're involving -- and inviting comment from -- providers who deliver the services, Oregonians who receive the services, researchers and other professionals in the field, and from the public.

People deserve to have the same science-backed confidence in their addiction and mental-health treatment as you demand from your family physician. Oregon is ensuring they have it.

Bob Nikkel is administrator of the Office of Mental Health and Addiction Services in the Oregon Department of Human Services. He can be reached at robert.e.nikkel@state.or.us