Abstract
Approximately 20 percent of Americans are affected by mental health and substance use
disorders, which are associated with significant morbidity and mortality. While the evidence
base for the effectiveness of interventions to treat these disorders is sizable, a considerable gap
exists between what is known to be effective and interventions that are actually delivered in
clinical care. Addressing this quality chasm in mental health and substance use care is
particularly critical given the recent passage of the Patient Protection and Affordable Care Act
(ACA) and Mental Health Parity and Addiction Equity Act, which are changing the delivery of
care and access to treatments for mental health and substance use disorders. Increasing
emphasis on accountability and performance measurement, moreover, will require strategies to
promote and measure the quality of psychosocial interventions.
In this report, the study committee develops a framework that can be used to chart a path
toward the ultimate goal of improving the outcomes of psychosocial interventions for those with
mental health and substance use disorders. This framework identifies the key steps entailed in
successfully bringing an evidence-based psychosocial intervention into clinical practice. It
highlights the need to (1) support research to strengthen the evidence base on the efficacy and
effectiveness of psychosocial interventions; (2) based on this evidence, identify the key elements
that drive an intervention’s effect; (3) conduct systematic reviews to inform clinical guidelines
that incorporate these key elements; (4) using the findings of these systematic reviews, develop
quality measures—measures of the structure, process, and outcomes of interventions; and
(5) establish methods for successfully implementing and sustaining these interventions in regular
practice including the training of providers of these interventions. The committee intends for this
framework to be an iterative one, with the results of the process being fed back into the evidence
base and the cycle beginning anew. Central to the framework is the importance of using the
consumer perspective to inform the process.
The recommendations offered in this report are intended to assist policy makers, health
care organizations, and payers that are organizing and overseeing the provision of care for
mental health and substance use disorders while navigating a new health care landscape. The
recommendations also target providers, professional societies, funding agencies, consumers, and
researchers, all of whom have a stake in ensuring that evidence-based, high-quality care is
provided to individuals receiving mental health and substance use services.