A United Nations General Assembly Special Session for mental, neurological, and substance use disorders: the time has come.

Mental, neurological, and substance use (MNS) disorders are leading causes of the global burden of disease and profoundly impact the social and economic well-being of individuals and communities. The majority of people affected by MNS disorders globally do not have access to evidence-based interventions and many experience discrimination and abuses of their human rights. A United Nations General Assembly Special Session (UNGASS) is needed to focus global attention on MNS disorders as a core development issue requiring commitments to improve access to care, promote human rights, and strengthen the evidence on effective prevention and treatment.

Non-communicable diseases and the mental health gap: what is to be done?

The increasing evidence base for cost-effective interventions and a fledgling advocacy effort have given momentum to mental health becoming a global priority. The contention of this editorial is that we are at a tipping point if we can exploit the opportunities that will be afforded to mental health professionals and advocates in the next year or two. The missing links are the development of consensus among mental health stakeholders, the formation of coalitions and partnerships with both advocates and policy-makers, and the mobilisation of a stronger advocacy effort built around consumer and family member 'voice' and empowerment.

The State Health Authority Yardstick (SHAY).

State mental health authorities have a leadership role in implementing evidence-based practices (EBPs), but few instruments are available to assess the impact of this role. We describe the development of the State Mental Health Authority Yardstick (SHAY), a behaviorally anchored instrument designed to assess state-level facilitating conditions associated with successful implementation of EBPs in community mental health centers. The SHAY assesses the SMHA role in seven domains: Planning, Financing, Training, Leadership, Policies and Regulations, Quality Improvement, and Stakeholders. Preliminary evidence from the National Evidence-Based Practices Project partially supports the construct and criterion-oriented validity of this instrument for rating state-level activities supporting or blocking the implementation of evidence-based practices.

Mental health transformation: moving toward a public health, early-intervention approach in Texas.

This column describes a mental health system transformation initiative in Texas that aims to fully integrate mental health as a component of public health and early-intervention efforts. The process has included a formal needs assessment initiative and a broad-based interagency Transformation Workgroup made up of executive-level agency staff, consumers and family members, and representatives of the legislature and governor's office. Community collaboratives have been formed to instigate transformation at the local level. Major objectives include development of consumer and family networks, workforce development and training, and an improved data and technology infrastructure.

The role of state mental health authorities in managing change for the implementation of evidence-based practices.

The evidence-based practice demonstration for services to adults with serious mental illness has ended its pilot stage. This paper presents the approaches states employed to combine traditional policy levers with more strategic/institutional efforts (e.g., leadership) to facilitate implementation of these practices. Two rounds of site visits were completed and extensive interview data collected. The data were analyzed to find trends that were consistent across states and across practices. Two themes emerged for understanding implementation of evidence-based practices: the support and influence of the state mental health authority matters and so does the structure of the mental health systems.

The state policy context of implementation issues for evidence-based practices in mental health.

OBJECTIVES: This study analyzed implementation issues related to several evidence-based practices for adults with serious mental illness that were included in a national demonstration project. The five evidence-based practices included in this investigation are assertive community treatment, family psychoeducation, illness management and recovery, integrated dual diagnosis treatment, and supported employment. The objective of the study was to assess the role of state mental health authorities as agents of change. METHODS: Two-person teams conducted interviews with state mental health authorities, consumers, families, representatives of local mental health authorities, and representatives of other relevant state agencies--more than 30 individuals at each of the eight sites. Interviews took place at two time points at least one year apart and probed the facilitators and barriers to implementation at the state level. Data were assessed qualitatively to identify common trends and issues across states related to leadership, training, and regulatory issues for each evidence-based practice. RESULTS: Each of the five practices has different critical contingencies for statewide implementation and requires unique assets to address those contingencies by the state mental health authorities. The contingencies are related to these critical areas: financing and regulations, leadership, and training and quality. CONCLUSIONS: States are key to implementing evidence-based practices, but state mental health authorities should note that each of the practices requires different skill sets and involves different stakeholders. Thus implementing many evidence-based practices at once may not yield economies of scale.

Mental health quality and accountability: the role of evidence-based practices and performance measurement.

Both evidence-based practices and performance measurement in mental health systems have been implemented as largely independent initiatives, each facing issues related to system-wide, sustained implementation. A major thrust of this article is that a broader quality and accountability framework is critical for obtaining better outcomes and for incorporating these initiatives into business as usual. This article provides an overview of national initiatives in these areas, lessons learned from implementation efforts, and problems encountered. Building on these experiences, a model for a quality and accountability framework is proposed in which evidence-based practices and performance measurement systems can together provide productive and ongoing synergy.

Implementation of evidence-based practices in state mental health systems: implications for research and effectiveness studies.

There is a huge gap between knowledge and practice, and between what is known through research and what is actually implemented in public mental health systems. In the past 2 decades, rigorous research has demonstrated the effectiveness of various treatments and interventions but these findings have not resulted in broad-based implementation. A major contention of this article is that while there is a growing body of knowledge related to evidence-based practices, there is a lack of understanding and research related to factors critical for implementation. This article reviews the current status of implementation of evidence-based practices in the public mental health system and identifies challenges and barriers related to their dissemination. Based on this analysis, this article proposes a research agenda that promotes the development of a science of implementation of evidence-based practices.

Evidence-based practices: setting the context and responding to concerns.

After nearly 20 years of progress in general medicine, the evidence-based practice movement is becoming the central theme for mental health care reform in the first decade of 2000. Several leaders in the movement met to discuss concerns raised by six stakeholder groups: consumers, family members, practitioners, administrators, policy makers, and researchers. Recurrent themes relate to concerns regarding the limits of science, diversion of funding from valued practices, increased costs, feasibility, prior investments in other practices, and shifts in power and control. The authors recommend that all stakeholder groups be involved in further dialog and planning to ensure that practices emerge that represent the integration of the best research evidence with clinical expertise and consumer values.

Educational best practices.

There are few reports from the behavioral health field that focus on educational best practices. This article summarizes a panel presentation from the Annapolis Conference in which four different programs were described: (1) a provider educational initiative, (2) a tool-kit project related to evidence-based services, (3) a multidisciplinary faculty training program in addictions, and (4) an AIDS education project. While such innovative educational practices appear to be the exception rather than the norm, they do offer ideas and strategies for challenging and energizing current educational practices in behavioral health.