ments and that some professional education and training programs have been reluctant to incorporate clinical practice guidelines in traditional classroom content as well as clinical education placements (Hoge et al., 2002). Moreover, quality improvement strategies have received little attention in M/SU education (Morris et al., 2004). Similarly, despite the need for interprofessional collaboration described in Chapter 5, graduate training in M/SU health care continues to be conducted in single-discipline silos with little interdisciplinary coordination. Multispecialty training, such as that involving both mental health and primary care providers, also remains infrequent (Hoge et al., 2002).

Further, available information shows that there is no agreed-upon level of competency within any profession (or across professions) with respect to providing M/SU health care. Graduate training has not kept pace with changes in health care delivery, and the achievement of expected educational outcomes has not been demonstrated (Hoge et al., 2002). Recent changes in the licensing examination for nurses have decreased the content devoted to psychosocial issues, which some fear will encourage nursing schools to weaken mental health content in their curriculums (Poster, 2004). There also is strong evidence that education of all clinicians inadequately addresses substance-use problems and illnesses despite their high rates of co-occurrence with mental problems and illnesses.

A primary concern regarding M/SU clinicians’ education and training is the general absence of clearly specified competencies that students are to develop and a process for routinely assessing whether those competencies have actually been achieved. Leaders in the education of M/SU health care clinicians cite a historical reluctance in some professional education and training programs to require students to demonstrate competence in specific treatments, and note that general M/SU graduate education does not guarantee competence in advanced or specialized skills. As a result, it is recommended that training programs specify the minimum competencies expected of their graduates and verify that these competencies have been achieved (Hoge et al., 2002).

Multiple organizations are in various (mainly early) stages of developing discipline-specific, population-specific, or subject matter-specific competencies for clinicians providing health care for mental or substance-use conditions. However, these competencies have not yet been adopted as standards of professional practice, and together represent a not-yet-finished “patchwork quilt” of competencies. Moreover, still less attention has been directed to developing and implementing strategies for assessing the extent