Q: You’ve said the country’s mental health crisis is “not a research problem, it’s an implementation problem.” What do you see as the role of organizations like the Meadows Institute in addressing that implementation problem?

A: As a scientist who has devoted a long career to research on brain and behavior, I want to see a lot more science in the future. Science is our best hope for new treatments. That said, our mental health crisis is not because of a lack of science—it’s about a lack of care. It’s a little bit like the gap between developing vaccines and delivering vaccinations. In the mental health world, we have good things to offer but few people are getting the treatments that work when those treatments are most effective. The fix for implementation is more about policy than research, so the Meadows Institute has a huge role to play by supporting policies that improve the implementation of high-quality care.

Q: You are sounding an alarm about the need to effectively address mental illness. From our experiences in Texas, people seem to understand the importance of mental health perhaps better than ever before. Have you noticed such a change, whether in Texas or elsewhere? What are the signs that we are heading in the right direction?

A: I think mental health is more personal than political. This is a bipartisan issue. But it still is not discussed enough. One important change is the way that young people are talking openly about mental health and mental illness. Sometimes I almost wonder if mental health issues have become too popular among high school and college students. That would have been unthinkable a decade ago when we worried about “stigma.”

Still, it is important for us to find the right language. I like to talk about brain capital, making sure the next generation has the skills to succeed and compete. I also think we need to distinguish between serious mental illness and the broad topic of mental health or brain health. I’d like to see us address serious mental illness more effectively, with a goal of reducing incarceration, homelessness, and early mortality. I think we talk about the consequences but not enough about the causes: untreated mental illnesses.

Q: During your remarks at Engage & Excel, you said, “You can’t manage what you can’t measure. You’ve got to start measuring if you’re going to make progress.” Can you speak a bit more on the importance of measurement-based care?

A: If you don’t measure outcomes, you don’t learn and you don’t improve. I think this is one of the reasons that outcomes have not improved in our field. But this is entirely fixable. Whether through patient-reported outcomes, clinician ratings, or digital tools, we can measure the impact of our treatments. Telehealth should bake measurement into every clinical interaction. Eventually, we should expect reimbursement to be based on outcomes. That is the essence of value-based care. Much of medicine is moving in this direction, but mental health will need to adopt measurement-based care if we want to catch up.

Q: What are the obstacles to making measurement-based care the standard, rather than the exception?

A: For better or worse, health care in the U.S. is a business. It follows that, if you want to change provider behavior, you change how providers get paid. I used to say when I was in government, “Maybe we can’t herd cats, but we can move their food.” When provider reimbursement requires measurement-based care, you will be amazed how quickly this gets adopted. Of course, measurement-based care will introduce its own set of problems. We have seen this disaster in medicine where providers spend more time checking boxes than checking patients. That is not progress. And it would be a particular irony if mental health providers, masters of empathic listening, started spending more time filling out forms than relating to patients. No one wants that. I get it when people say, “Not everything that can be counted counts, and not everything that counts can be counted.” Fair enough, but we can’t assume that perpetuating our failure to measure and learn will lead to better outcomes. We need to do better.

Q: How optimistic are you that we’ll be able to make the kinds of changes we need to have a real impact on mental health care, both in Texas and beyond?

A: Texas is a great place to lead in mental health reform. And I use the word “lead” intentionally. What we need today is not just evidence-based practice. We need practice-based evidence, leading with real data from the world of care about changing outcomes at scale. In addition to measurement-based care, implementing three policies—collaborative care, coordinated specialty care (for first-episode psychosis), and Certified Community Behavioral Health Clinics—are areas where the Meadows Institute is already creating important programs in Texas. I think mental health is finally having its moment. We are seeing new investment, new innovation, and new implementation. Texas can lead in all of these important areas.