Review article
Public policy and evidence-based practice

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Evidence-based practices1

The main finding of the US Surgeon General's 1999 report on mental health is that treatment efficacy is well documented for a range of treatments for most mental disorders [1]. Individuals who experience a mental disorder or mental health problem are encouraged to seek help by choosing from this range of treatments to suit their preferences. The report alerted the public, mental health advocates, and policymakers to the disparity between the opportunities for improving treatment and services

Quality and accountability

Quality and accountability have become the watchwords of health and mental health services [2]. Implementing EBP has become a means to achieving both ends. In this context, quality means positive outcomes obtained by using cost-effective services, and accountability means documentation of adherence to EBP. There are many other approaches to achieving quality mental health services; this article, however, deals only with EBP.

Michael Hogan, commissioner of Mental Health in Ohio and chairman of

Initiatives in implementing evidence-based practice

A preliminary review of state activities in 2001 based on the reports of 47 states indicates that every reporting state is involved with EBP in some fashion; most are implementing three or more practices [15]. EBP involvement ranges from 16 states using some form of medication algorithm to 43 states involved in supported employment. Implementation is rarely statewide, however (eg, only 12 of the 41 states reporting use of assertive community treatment say that it is available or being

Overcoming systemic barriers

Although the focus on mental health policy has shifted from organization and financing to the content and quality of services, policymakers cannot ignore systemic barriers to implementing EBP. Each of the articles in the literature describing specific EBPs also has identified barriers related to organizational policy and financing policy, and some have identified strategies for overcoming those barriers and creating appropriate incentives to support implementation. The Surgeon General's report

Policy recommendations

This section discusses eight specific policy recommendations for facilitating the implementation of EBP in routine mental health care practice. These recommendations are summarized in Table 1.

Summary

The time has come to add to the body of EBP implementation knowledge at multiple levels, including knowledge about policy, program priorities, clinician practice, consumer adherence, and family member support. Implementation at the policy level, however, is primary and paramount. The national initiative supporting EBP implementation is one of the most important innovations on the mental health horizon. It will serve as the testing ground for what can be learned about bridging the gap between

Acknowledgements

The authors wish to acknowledge Rodolfo Arredondo, Charles Curie, Stanley Eichenauer, Wayne Fenton, Daniel Fisher, Anil Godbole, Norwood Knight-Richardson, Henry Harbin, Michael Hogan, Garrett Moran, Richard Nakamura, Robert Postelthwaite, Glenn Stanton, and Dee Yates for their thoughtful reviews of earlier drafts of this paper.

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This paper originally was prepared for consideration by the President's New Freedom Commission on Mental Health.

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