Implementing Evidence-Based Practices for Persons With Severe Mental Illnesses

Abstract

Extensive empirical research, summarized in several reviews and codified in practice guidelines, recommendations, and algorithms, demonstrates that several pharmacological and psychosocial interventions are effective in improving the lives of persons with severe mental illnesses. Yet the practices validated by research are not widely offered in routine mental health practice settings. As part of an effort to promote the implementation of evidence-based practice, the authors summarize perspectives on how best to change and sustain effective practice from the research literature and from the experiences of administrators, clinicians, family advocates, and services researchers. They describe an implementation plan for evidence-based practices based on the use of toolkits to promote the consistent delivery of such practices. The toolkits will include integrated written material, Web-based resources, training experiences, and consultation opportunities. Special materials will address the concerns of mental health authorities (funders), administrators of provider organizations, clinicians, and consumers and their families.

The process of implementing a new working method - a project towards change in a Swedish psychiatric clinic

“…This finding is consistent with previous studies revealing the difficulties associated with implementing new practices in healthcare [22][23][24][25]54] . Table 3.…”

“…the new method was resourceand time-consuming [18,33,56] . This finding is in accordance with previous results suggesting that implementing new methods, models or practices in mental healthcare or healthcare is typically difficult [15,[22][23][24][25] . According to Rashid et al, it is important to understand the organizational culture before initiating projects towards change [57] .…”

“…Drake et al define evidence-based practices in mental health service settings as "interventions for which there is consistent scientific evidence showing that they improve client outcomes" [21] . Torrey et al mean that implementing evidence-based practices in mental health practice is difficult and complex [22][23][24][25] . Several psychiatric nursing care models have been implemented in healthcare, some more successfully than others [26][27][28] .…”

The Evidence For and Against Evidence-Based Practice

“…For example, in 1998 a Robert Wood Johnson Foundation consensus panel concluded that its review of research findings supported identification of several evidence-based psychosocial practices for the treatment of persons with severe mental illness: assertive community treatment, supported employment, family psychoeducation, recovery skills training and illness self-management, standardized pharmacological treatment, and integrated dual-disorder treatment. To be considered EBP, four selection criteria were used: (1) the treatment practices had been standardized through manuals or guidelines, (2) the treatment practices had been evaluated with controlled research designs, (3) important outcomes were demonstrated through the use of objective measures, and (4) the research was conducted by different research teams (Torrey et al, 2001). Accordingly, we can say that EBPs were identified for the treatment of persons with severe mental illness through efficacy trials meeting these four criteria.…”

AcademyHealth 25th Annual Research Meeting Chair Address: From a Science of Recommendation to a Science of Implementation

“…Ignoring the serious barriers to evidence use (e.g., time pressures, perceived threats to autonomy, the preference for ''colloquial'' knowledge based on individual experiences, difficulty in accessing the evidence base, difficulty differentiating useful and accurate evidence from that which is inaccurate or inapplicable, and lack of resources) may only serve to convince users of the information that research evidence does not work for them. Moreover, the changes required to translate and implement evidence-based care demand restructuring the usual routine of daily work so that there is a smooth transition--it requires letting go of old and competing demands to enable the adoption of the new way of providing care (Torrey et al 2001). And more importantly, something that seems to be routinely disregarded in the translation and implementation of evidence is that the new evidence must ring true with the values and experience of providers, patients, and policy makers (Torrey et al 2001).…”