Practice Guidelines in Mental Health and Addiction Services: Contributions from the American College of Mental Health Administration

  • Gail W. Stuart
  • A. John Rush
  • John A. Morris


Practice guidelines have proliferated in mental health and addiction services; more than 40 organizations have developed guidelines in the field. However, much confusion, controversy, and contextual issues remain, particularly regarding effective dissemination and the clinical, financial, political, and ethical issues that emerge when evidence-based behavioral health practice guidelines are implemented in systems of care. The American College of Mental Health Administration (ACMHA) focused on these problems in their 1999 and 2000 Santa Fe Summits and produced a number of specific outcomes that contribute to thinking in the field. These include the following: (a) a taxonomy of building blocks for informed decision-making in behavioral health assessment and treatment; (b) a paradigm for the development of practice guidelines; (c) characteristics of a good practice guideline; (d) strategies for disseminating and implementing practice guidelines; and (e) areas in need of future research.

algorithms best practices evidence-based practice practice guidelines 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abrahamson, D. (1998, June). Ethical and political issues in practice guidelines implementation. Behavioral Healthcare Tomorrow, 32-40.Google Scholar
  2. American College of Mental Health Administration. (1998). Preserving quality and value in the managed care equation. Pittsburgh, PA: American College of Mental Health Administration.Google Scholar
  3. Bauer, M.S. (1998). Clinical practice guidelines: The academic emperor in search of clinical practice clothes. Unpublished manuscript.Google Scholar
  4. Bond, G., Becker, D., Drake, R., Rapp, C., Meisler, N., Lehman, A., Bell, M. & Blyler, C. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52(3), 313-322.Google Scholar
  5. Brown, J., Shye, D., & McFarland, B. (1995). The paradox of guideline implementation: How AHCPR's depression guideline was adapted at Kaiser Permanente Northwest Region. Journal of Quality Improvement, 21(1), 5-21.Google Scholar
  6. Brown, J., Shye, D., McFarland, B., Nichols, G., Mulloly, J., & Johnson, R. (2000). Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression. Journal of Quality Improvement, 26(1), 39-45.Google Scholar
  7. Cabana, M., Rand, C., Powe, N., Wu, A., Wilson, M., Abboud, P., & Rubin, H. (1999). Why don't physicians follow practice guidelines? JAMA, 282(15), 1458-1465.Google Scholar
  8. Citrome, L. (1998). Practice protocols, parameters, pathways, and guidelines. Administration and Policy in Mental Health, 25(3), 257-269.Google Scholar
  9. Drake, R., Essock, S., Shaner, A., Carey, K., Minkoff, K., Kola, L., Lynde, D., Osher, F., Clark, R., & Richards, L. (in press). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services.Google Scholar
  10. Drake, R., Goldman, H., Leff, H., Lehman, A., Dixon, L., Mueser, K., & Torrey, W. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179-182.Google Scholar
  11. Field, M.J., & Lohr, K.N. (Eds.). (1990). Clinical practice guidelines: Directions for a new program. Institute of Medicine. Washington, DC: National Academy Press.Google Scholar
  12. Gilbert, D.A., Altshuler, K.Z., Rago, W.V., Shon, S.P., Crismon, M.L., Toprac, M.G., & Rush, A.J. (1998). Texas Medication Algorithm Project: Definitions, rationale, and methods to develop medication algorithms. Journal of Clinical Psychiatry, 59(7), 345-351.Google Scholar
  13. Goldberg, H., Wagner, E., Fihn S., Martin, D., Horowitz, C., Christensen, D., Cheadle, A., Diehr, P., & Simon, G. (1998). A randomized controlled trial of CQI teams and academic detailing: Can they alter compliance with guidelines? Journal of Quality Improvement, 24(3), 130-142.Google Scholar
  14. Hamilton, J. (1999). The MBHO Guidelines Roll-Outs. In Kenneth M. Coughlin (Ed.), 2000 behavioral outcomes and guidelines sourcebook. New York: Faulkner & Gray. 33 Gail W. Stuart, A. John Rush, and John A. Morris Google Scholar
  15. Hayes, O.W. (1994). Clinical practice guidelines: A review. Journal of the American Osteopathic Association, 94, 732-738.Google Scholar
  16. Hayes, S.C. (1999, June). Science and the success of behavioral healthcare. Behavioral Healthcare Tomorrow Special Report: Quality & Accountability, 54-56.Google Scholar
  17. Lin, E., Katon, W., Simon, G., Von Korff, M., Bush, T., Rutter, C., Saunders, K., & Walker, E. (1997). Achieving guidelines for the treatment of depression in primary care: Is physician education enough? Medical Care, 35(8), 831-842.Google Scholar
  18. Lobach, D.F., & Underwood, H.R. (1998). Computer-based decision support systems for implementing clinical practice guidelines. Drug Benefit Trends, 10, 48-53.Google Scholar
  19. Margolius, C.Z., & Cretin, S. (Eds.). (1999). Implementing clinical practice guidelines. Chicago: American Hospital Association Press.Google Scholar
  20. Merz, S.M. (1993). Clinical practice guidelines: Policy issues and legal implications. The Joint Commission Journal on Quality Improvement, 19(8), 306-312.Google Scholar
  21. Nathan, P., & Gorman, J. (1998). A guide to treatments that work. New York: Oxford University Press.Google Scholar
  22. National Quality of Care Forum. (1993). Bridging the gap between theory and practice: Exploring clinical practice guidelines. The Joint Commission Journal on Quality Improvement, 19(9), 384-400.Google Scholar
  23. NHS Centre for Reviews and Dissemination. (1999). Getting evidence into practice. Effective Health Care, 5(1), 1-16.Google Scholar
  24. Noonan, D., Coursey, R., Edwards, J.B., Frances, A., Fritz, T., Henderson, M.J., Krauss, A., Leibfried, T., Manderscheid, R.W., Minden, S., & Strosahl, K. (1998). Clinical practice guidelines. Journal of the Washington Academy of Sciences, 85(1), 114-124.Google Scholar
  25. Oxman, A., Thomson, M., Davis, D., & Haynes, R. (1995, November). No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. Canadian Medical Association, 15, 1423-1431.Google Scholar
  26. Rush, A.J., Crismon, M.L., Toprac, M., Trivedi, M.H., Rago, W.V., Shon, S., & Altshuler, K.Z. (1998). Consensus guidelines in the treatment of major depressive disorder. Journal of Clinical Psychiatry, 59(Suppl. 20), 73-84.Google Scholar
  27. Sachs, G., & Gaughan, S. (1999). Clinical practice guidelines: Praise and problems. Journal of Clinical Psychiatry, 60(1), 7-8.Google Scholar
  28. Shon, S.P., Toprac, M.G., Crismon, M.L., & Rush, A.J. (1999, January). Strategies for implementing psychiatric medication algorithms in the public sector. Journal of Practical Psychiatry and Behavioral Health, 32-36.Google Scholar
  29. Stuart, G.W. (2001). Evidence-based psychiatric nursing practice. In G. Stuart, M. Laraia, Eds., Principles and Practice of Psychiatric Nursing. St. Louis, MO: Mosby.Google Scholar
  30. Thomas, L. (1999). Clinical practice guidelines. Evidence-Based Nursing, 2(2), 38-39.Google Scholar
  31. Torrey, W., Drake, R., Dixon, L., Burns, B., Flynn, L., Rush, A., Clark, R. & Klatzker, D. (2001). Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric Services, 52(1), 45-50.Google Scholar
  32. Trivedi, M., Kern, J., Baker, S., & Altshuler, K. (2000). Computerizing medication algorithms and decision support systems for major psychiatric disorders. Journal of Psychiatric Practice, 6, 237-246.Google Scholar
  33. Van Amringe, M., & Shannon, T.E. (1992, December). Awareness, assimilation, and adoption: The challenge of effective dissemination and the first AHCPR-sponsored guidelines. QRB, 397-404.Google Scholar
  34. Wade, W. (1999, June). Implementing practice guidelines. Behavioral Healthcare Tomorrow, 42-45.Google Scholar
  35. West, J., Leaf, P., & Zarin, D. (2000). Health plan characteristics and conformance with key practice guideline psychopharmacologic treatment recommendations for major depression. Mental Health Services Research, 2(4), 223-237.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2002

Authors and Affiliations

  • Gail W. Stuart
    • 1
    • 2
    • 3
  • A. John Rush
    • 4
  • John A. Morris
    • 5
  1. 1.College of MedicineMedical University of South CarolinaCharleston
  2. 2.College of NursingMedical University of South CarolinaCharleston
  3. 3.American College of Mental Health AdministrationPittsburgh
  4. 4.University of Texas Southwestern Medical CenterDallas
  5. 5.University of South Carolina School of MedicineColumbia

Personalised recommendations