Clinical Scorecard: Building Learning Mental Health Systems to Improve Care in the 21st Century: From Coordinated Services to Continuous Learning

At a Glance

Key Highlights

• The editorial calls for mental health systems to move beyond coordinated services toward integrated, person-centered systems.
• Lived and living experience should inform the design, delivery, and evaluation of mental health services and systems.
• The editorial states that inadequate service-user engagement and retention represent a service or system failure when users' needs remain unmet.
• Fragmented services are associated in the editorial with gaps, access obstacles, inequities, and accountability concerns; integrated system organization remains aspirational in nearly every country and is almost entirely absent across many low- and middle-income countries.
• The editorial emphasizes inclusion and the value of lived experience expertise in informing research and the development, delivery, and evaluation of services and systems.

Guideline-Based Recommendations

Diagnosis

Management

• Embed lived and living experience in mental health system design, research, service delivery, and evaluation.
• Develop integrated, person-centered systems with shared goals and governance, integrated infrastructure, and common information, policy, and evaluation frameworks.

Monitoring & Follow-up

• Include outcome measurement and evaluation in mental health system design and align definitions of success with lived experience.

Risks

• The editorial describes fragmented services and gaps, obstacles to access, inequities, and accountability concerns.
• The editorial states that adverse effects on service-user engagement and experience, treatment outcomes, and service efficiency and complexity have been documented.

Patient & Prescribing Data

People living with mental health challenges, including those with contact with services and people with lived experience expertise; families and loved ones are also identified as central to the purpose of care.

The editorial does not provide medication or prescribing guidance. It emphasizes person-centered care and the use of lived experience expertise in informing mental health services and systems.

Clinical Best Practices

• Treat lived experience expertise—the knowledge and skills developed through lived experience—as a source that can inform research and the development, delivery, and evaluation of services.
• Recognize agency, autonomy, and inclusion when designing systems for the people they are intended to serve.
• Recognize inadequate service-user engagement and retention as a service or system failure when users' needs remain unmet.
• Align prevention, access, care delivery, outcome measurement, evaluation, and definitions of success with lived experience.

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