Rebooting for Whom?

Abstract

We share Kazdin and Blase’s (2011) sense of urgency about finding better ways to reduce the burden of mental illness. Although effective psychosocial treatments exist, they do not often reach the patients who need them most. Kazdin and Blase’s portfolio approach aims to cast a wider net through increased use of technology, media, self-help, nonprofessional providers, and collaborations with other disciplines. It is unclear, however, whether reaching more people would suffice to reduce the burden of mental illness, much less offset the small effect sizes of simplified, scaled-down interventions such a portfolio approach would likely entail. We focus here on an underdeveloped theme in Kazdin and Blase’s essay—that bending the curve of mental illness will require better knowledge of for whom simplified intervention and prevention strategies will suffice and for whom more intensive intervention is necessary. Such “for whom” questions deserve a central place on the national research agenda as we move toward individualized or personalized health care. In the absence of such knowledge, we risk treatment decisions guided by accessibility to resources rather than patient needs—the very problem Kazdin and Blase aim to solve.