What is the Texas Medication Algorithm Project?

Introduction

The Texas Medication Algorithm Project (TMAP) is a controversial decision-tree medical algorithm, the design of which was based on the expert opinions of mental health specialists.

It has provided and rolled out a set of psychiatric management guidelines for doctors treating certain mental disorders within Texas’ publicly funded mental health care system, along with manuals relating to each of them. The algorithms commence after diagnosis and cover pharmacological treatment (hence “Medication Algorithm”).

Brief History

TMAP was initiated in the fall (winter) of 1997 and the initial research covered around 500 patients.

TMAP arose from a collaboration that began in 1995 between the Texas Department of Mental Health and Mental Retardation (TDMHMR), pharmaceutical companies, and the University of Texas Southwestern. The research was supported by the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Meadows Foundation, the Lightner-Sams Foundation, the Nanny Hogan Boyd Charitable Trust, TDMHMR, the Centre for Mental Health Services, the Department of Veterans Affairs, the Health Services Research and Development Research Career Scientist Award, the United States Pharmacopoeia Convention Inc. and Mental Health Connections.

Numerous companies that invent and develop antipsychotic medications provided use of their medications and furnished funding for the project. Companies did not participate in the production of the guidelines.

In 2004 TMAP was mentioned as an example of a successful project in a paper regarding implementing mental health screening programmes throughout the United States, by the President George W. Bush’s New Freedom Commission on Mental Health, which looks to expand the programme federally. The President had previously been Governor of Texas, in the period when TMAP was implemented. Similar programmes have been implemented in about a dozen States, according to a 2004 report in the British Medical Journal.

Similar algorithms with similar prescribing advice have been produced elsewhere, for instance at the Maudsley Hospital, London.

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