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In the third article of a five-part series providing a global perspective on integrating mental health, Victoria Ngo and colleagues discuss the benefits and requirements of collaborative care models, where non-communicable disease and mental health care are integrated and provided in the primary care setting. Please see later in the article for the Editors' Summary

The authors describe the policy and administrative-practice implications of implementing evidence-based services, particularly in public-sector settings. They review the observations of the contributors to the evidence-based practices series published throughout 2001 in Psychiatric Services. Quality and accountability have become the watchwords of health and mental health services; evidence-based practices are a means to both ends. If the objective of accountable, high-quality services is to be achieved by implementing evidence-based practices, the right incentives must be put in place, and systemic barriers must be overcome. The authors use the framework from the U.S. Surgeon General's 1999 report on mental health to describe eight courses of action for addressing the gap between science and practice: continue to build the science base; overcome stigma; improve public awareness of effective treatments; ensure the supply of mental health services and providers; ensure delivery of state-of-the-art treatments; tailor treatment to age, sex, race, and culture; facilitate entry into treatment; and reduce financial barriers to treatment.

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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.

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.

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.

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.