Officials defend ending ‘flawed’ mental health, drug abuse program registry

The Trump administration ended a national database for evidence-based mental health and substance abuse programs because it was “flawed” and potentially dangerous, officials said Thursday. 

The administration announced earlier this month it would discontinue the database, which was created in 1997 to help people, agencies and organizations identify and implement evidence-based programs and practices in their communities. 

But officials told reporters on a press call Thursday that the database, called the National Registry of Evidence-Based Programs and Practices (NREPP), virtually ignored serious mental illnesses and drug abuse disorders, and that its standards for including programs in the registry were poor. 

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“I believe at SAMHSA we should not be encouraging providers to use NREPP to obtain evidence-based practices given the flawed nature of the system,” said Elinore McCance-Katz, the assistant secretary for mental health and substance use at the Department of Health and Human Services who heads up the department’s Substance Abuse and Mental Health Services Administration (SAMHSA).

To be added to the database, a program or intervention must be reviewed by an independent contractor to ensure it’s scientifically sound and effective. 

But McCance-Katz argued that isn’t always the case. 

She said some practices listed in the database are “entirely irrelevant” to some disorders and some have little evidence proving they are effective. It also failed to address the needs of those with serious mental health issues and drug abuse disorders, she said. 

The website has been frozen and is being reviewed by an in-house “policy lab.” 

There are no current plans to remove it but “we are moving in a new direction,” McCance-Katz said. “NREPP will not continue in its present form.” 

She said her agency is still focused on the development and implementation of evidence-based programs and the policy lab is working to identify a new approach, which will involve working with the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and other agencies that can “comment on what constitutes evidence-based practices.” 

“We are now moving to implementation efforts through targeted technical assistance and training that makes use of local and national experts and that assist programs with actually implementing services that will be essential to getting Americans living with these disorders the care and treatment and recovery services that they need,” she said. 

McCance-Katz said she first questioned the program when she was SAMHSA’s chief medical officer from 2013 to 2015. 

When she became assistant secretary for mental health and substance use, she knew NREPP would be one of the first things she would address. 

She said the database, for example, doesn’t include any information about medicated-assisted treatment (MAT), which is often used to treat opioid abuse disorder.

Only one-third of specialty substance abuse treatment programs in the country offer MAT, she said.

That “tells me we need to do something different, and fast,” she added. 

“We have an emergency going on, and we in the Trump administration are not going to sit back and allow Americans to die while we simply leave things up on our website that don’t help people.”