States Experiencing Barriers to Implementing Evidence-Based Practice in Public Mental Health Settings

Purpose:  Evidence-based practice (EBP) has become a national issue in public mental health.   In 1999 the Surgeon General challenged the mental health community to expand the supply of EBP services.  In 2002 The President’s New Freedom Commission indicated that EBP was essential to the transformation of mental health system. In January, 2013 the Substance Abuse and Mental Health Services Administration Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues presented worker shortage as a barrier to implementing evidence-based practice in public mental health.  This study utilized data, collected by the National Research Institute, Inc., to analyze barriers to implementing EBP services in the public mental health system comparing 2004 data to 2012 data.  Results indicate significant barriers exist to implementing EBP services in public mental health including an untrained workforce. 

Method: Data from the National Research Institute, Inc. was utilized comparing data from 2004 to 2012.  The National Research Institute, Inc. collects data from State Mental Health Directors every two years.  The data on barriers, financing issues in paying for EBP’s, shortage of appropriately trained workforce, attaining and maintaining fidelity to EBP models standards, modification of the EBP model to meet local needs, resistance to implementing EBP’s from providers and other, were included in the study.  Descriptive data is presented on percentage of states reporting barriers to implementing EBP in public mental health settings in the United States.

Results: Data shows that there has been an increase (from 2004 to 2012) in the number of states reporting financing issues in paying for EBP’s, attaining and maintaining fidelity to EBP model standards, modification of the EBP model to meet local needs and other, as barriers to implementing EBP’s.  Data also shows a decrease in states reporting (from 2004 to 2012), shortage of appropriately trained workforce and resistance to implementing EBP’s from providers as barriers to implementing EBP’s in the United States. Both increases and decreases in barriers were minimal.

Conclusions and Implications:  This study shows that there continue to be significant barriers to implementing EBP in public mental health in the United States with 4 of the 6 barriers showing and increase in the number of states reporting them as a barrier to implementing EBP.  There was only a one percent point drop (2004 = 38%, 2012 = 37%) in the number of states reporting a shortage of appropriately trained workforce as a barrier to implementing EBP.  This is important to the field of social work because social workers provide more mental health services than any other discipline.  The findings suggest that social workers may not be adequately trained to implement EBP in public mental health.  Universities training social workers should examine their curriculum to ensure that students receive training in EBP to prepare them for the mental health workforce.  Strategies for preparing students to become evidence-based practitioners will be presented.