University-based researchers often contact our network, hoping to do research in our health systems to evaluate new interventions or programs. Those new interventions or programs are usually specific adaptations of treatments already proven to work. Typical examples (slightly anonymized) include: a care management program for people with depression and rheumatoid arthritis, a mobile health intervention teaching mindfulness skills after psychiatric hospital discharge, or a training program to help clinicians provide structured psychotherapy specific to bereavement.
When we bring these very specific ideas to leaders of our healthcare systems, they are not enthusiastic. While they are very interested in care management for depression, they are less interested in a program specific to depression and arthritis. They are certainly interested in mobile health programs and in mindfulness skills, but less interested in a program limited to the month after psychiatric hospitalization. And they are definitely interested in training to deliver empirically supported psychotherapies, but less interested in condition-specific training packages. To summarize: they are interested in innovation, but only if that innovation can be affordable, widely acceptable, and broadly available across our health systems.
Researchers focused on narrower questions are following the standard advice to all young mental health or health services researchers: Find your niche.
The traditional academic career path certainly encourages specialization. During graduate school, an aspiring researcher might join a research team studying collaborative care interventions for depression in people with chronic medical illness. During her postdoctoral fellowship, she works in the medical center’s Rheumatology clinic and customizes collaborative care materials for people with arthritis. She writes a career development application to refine and pilot-test collaborative care interventions for people with depression and arthritis. NIH reviewers point out that different types of arthritis are too heterogeneous, so she revises her approach to focus on rheumatoid arthritis specifically. And then she contacts us about doing this research in MHRN health systems. She has found her niche…. But leaders of our health systems are just not interested.
If you look at the career paths of our MHRN investigators, you’d think that none of us have found a niche. You’d find a health psychologist who began studying school-based health promotion and now studies implementation and health disparities. And you’d find a social worker who leads a large precision medicine consortium. And a geriatric psychiatrist studying EHR decision support and psychosocial interventions to prevent suicide attempt. Over time, they have traveled across diverse clinical topics, research methods, and care settings. I expect they will keep traveling. They are opportunists in the most positive sense of the word, always asking “What’s the most important problem that I could actually help with in the next few years?”
Maybe our niche is just to be as useful as we can. Not all who wander are lost. And sometimes they find useful things.