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The purpose of this report is to inform policymakers about the significance of recent advances in evaluating evidence for allocating resources to and within public mental health programs. These advances are of particular importance because the public sector is the largest payer for services to persons with chronic mental illness.

The authors’ central point is that the best evidence yields both good and bad news. The good news is that “many potentially available treatments and services” have been shown to produce “improved symptoms and functioning” in patients with severe, persistent mental illness. The bad is that “there are substantial gaps between what science tells us to do and what we do in actual practice, despite the significant investment of public resources.”

The research about which the authors report is increasingly useful to policymakers and clinicians. Many scientists are working collaboratively, often across national boundaries, to collect, analyze, and synthesize evidence about interventions to prevent and treat illness. A recent Milbank Report describes this international scientific advance (Ray Moynihan, Evaluating Health Services: A Reporter Covers the Science of Research Synthesis).

This report on the significance for policy of evidence about mental health services began as a request from policymakers. Leaders in the legislative and executive branches of government in Maryland asked the Milbank Memorial Fund to collaborate in organizing a meeting to discuss the strengths and weaknesses of that state’s public mental health programs. The Fund asked Anthony Lehman, Chair of the Department of Psychiatry at the University of Maryland School of Medicine, to prepare a background paper on evidence-based mental health treatments and services for this meeting. Lehman, a national leader in urging that the best available evidence should guide mental health services, invited his departmental colleagues Howard Goldman and Lisa Dixon to be coauthors. Because of the international reach of the science that underlies evidence-based practice, Lehman also invited Rachel Churchill, the London-based Coordinating Editor of the Cochrane Collaboration’s Depression, Anxiety and Neurosis Review Group, to be a coauthor. The Cochrane Collaboration is the leading international organization in reviewing systematically evidence about health services.

The Fund invited policymakers, researchers, and clinicians to review this report in draft; they are listed in the Acknowledgments. As a result of both the authors’ and reviewers’ expertise, this report is a useful guide for understanding how science can inform policy for mental health services.

Daniel M. Fox
President

Samuel L. Milbank
Chairman