practice. These practitioners are trained apart from each other—in different schools by different faculties, with curriculums encompassing few if any core competencies and little interdisciplinary training. Further, despite the wide variety of theories and therapies that have been developed to deal with M/SU problems and illnesses (see Chapter 4), there are no mechanisms in place to ensure that any given clinician has been adequately educated and trained to offer any specific therapy. Such a process is essential to the provision of safe, effective, and efficient care. The wide variety of provider types and treatments makes it difficult to provide consumers of M/SU health care with information on the competencies of any particular practitioner and to assist them in finding the right clinician for help, a key element of patient-centered care. Variations in state licensing requirements further complicate efforts to reduce inappropriate variations in care.

There is a long history of short-lived and unheeded commissions, expert panels, reports, and recommendations to improve the capacity and quality of the M/SU workforce. Reports dealing with the general health care workforce typically have failed to address the unique issues in M/SU health care. Those that have done so have addressed either mental health or substance use, but not both. Substance use, despite its magnitude and high rate of comorbidity with mental health problems, is often neglected in the professional training of all the major mental health disciplines and the training received by primary health care practitioners as well. Training does not sufficiently emphasize the advances made in evidence-based practice for treatment of mental and substance-use conditions, nor does it include enough content on self-help groups, community systems of support, and social services. Teaching methods across all the schools in which the M/SU disciplines are trained vary substantially as well, reflecting little cognizance of the advances that have been made in evidence-based teaching methods and lifelong learning.

Past recommendations calling for changes in the curriculums and methods for educating and training M/SU practitioners have typically been ignored. As a result, there continues to be a large gap between what is known, what is taught, and therefore what is done in practice. Sustained, multiyear attention and resources have been applied successfully to the education and training of physicians and nurses through the Council on Graduate Medical Education and the National Advisory Council on Nurse Education and Practice. A similar sustained, multiyear strategy, as well as action by institutions of higher education, licensing boards, accrediting



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