Implementation and translation science in the mental health practice and service delivery context: a review of existing reviews

Implementation and translation science in the mental health practice and service delivery context: a review of existing reviews | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Implementation and translation science in the mental health practice and service delivery context: a review of existing reviews Justine Fletcher, Pricilla Ennals, Dianna G Smith, Julia De Nicola, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9193899/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Ensuring findings from research directly influence practice in mental health services has been limited despite policy-based support for reform and innovation. Implementation of evidence-informed interventions and models of care in mental health services is challenging and is delaying potential benefits for people who access services. Even when evidence does inform changes in service delivery, it may not result in anticipated changes or be sustained or scaled as planned. This review aimed to explore how implementation and translation science is being applied to mental health services’ research and practice in high income countries and to identify the enablers and barriers to the implementation of evidence-informed approaches into service delivery. Methods In this review of reviews, we searched four databases: ProQuest Central, Medline, PsychInfo, and Cochrane to identify review papers that reported findings related to implementation of innovations in mental health services. The Consolidated Framework for Implementation Research (CFIR), a comprehensive framework for investigating and understanding the factors that influence implementation of innovations, was used to synthesise the data extracted from the reviews. Results Twelve reviews met the inclusion criteria, with most employing an implementation science framework to report their findings. After applying the CFIR, we found that the Inner Setting Domain and Individuals Domain of the CFIR were reported to have the most impact on implementation of innovations across various mental health settings. Conclusions Further prioritisation and application of implementation science is required to address the evidence to practice gap in mental health service delivery, and to deliver improved outcomes and experiences for people who uses mental health services. Service providers attempting to implement innovations require knowledge of factors that effectively drive and sustain change to optimise their implementation efforts. Implementation Science Consolidated Framework for Implementation Research Mental health research Mental health service Figures Figure 1 Contributions to the literature Identification of common strategies for and challenges to the implementation of evidence-informed interventions and models of care in mental health services Utilisation of implementation frameworks is important to inform implementation design and delivery and approaches to scaling When applying the CFIR to understand reviews it confirms the importance of attending to both the broader or external context and the internal operation of organisations when considering implementation of evidence-informed services Demonstrating the value of incorporating lived experience perspectives The CFIR domains of inner setting and individual were reported as having the most impact on innovation implementation in mental health services from 12 review papers, indicating these domains need close attention from mental health change implementers. Introduction Despite efforts to evaluate new and improved models of care and interventions for people experiencing mental ill-health, (1, 2) a bi-directional disconnection exists between service provision and research. Evidence generated through research is not always implemented into practice, and the realities of delivering or using mental health services are not routinely considered in shaping or translating research (3). Research describing existing or innovative approaches to care that demonstrate positive recovery outcomes for people experiencing mental ill-health or their family, carers, or kin reach service delivery inconsistently and are rarely embedded for the long term. Continuity remains precarious due to factors like insecure funding, shifting service and government priorities, and staff knowledge and acceptance of the innovation to be adopted. Conversely, localised implementation of some practice innovations may outpace existing evidence, making it difficult for services to embed these innovations consistently. Furthermore, involvement of lived experience in generating and critiquing evidence, as well as its implementation into practice, has been limited (4) and where it has occurred few studies report this in depth. There is a need for more effective implementation pathways that recognise a) service provision contexts, b) strong and promising research evidence, and c) lived and living experience perspectives, to enable contemporary, evidence-informed service provision that facilitates meaningful recovery. Implementation science examines the methods and strategies that promote the adoption, integration, and sustainability of evidence into practice (5). A significant lag in translating research evidence into routine practice settings has been recognised (6) with a range of factors hindering the pathways from evidence to practice. Moving from more controlled research contexts and participant groups to the varied contexts of service delivery may require further translation or adaptation of interventions or models of care. Creating space to innovate in busy service environments involves discontinuing low-value or outdated practices and this depends on reducing barriers and fostering change. While advances in implementation science highlight the complexity of factors involved in successful implementation, dominant methods of evidence generation often overlook or insufficiently consider relevant barriers and facilitators. They may also minimise the importance of key stakeholders, such as the end users of services. This reveals gaps in researchers' understanding and ability to integrate implementation theory and practice into their work (7). Implementation science offers guidance to researchers, policymakers, service leaders, and other change agents to better align research evidence with service delivery. Effective service improvement and reform that leads to improved recovery outcomes requires a stronger connection between research and practice, along with a focused approach to implementation. Some authors of this group are co-leads of the ALIVE National Centre for Mental Health Research Translation’s Implementation and Translation Network (ITN). This group supports implementation and translation research that enables earlier identification of needs across the life course and leads to embedding of preventive interventions to reduce future mental ill-health in various settings. As a group, we bring diverse knowledge and perspectives to research translation and implementation. Co-leads include people with lived experience of mental ill-health, emotional distress and service use, as well as intervention researchers, implementation scientists, epidemiologists, and service providers including general practitioners and mental health providers. This purposeful grouping of multiple perspectives shapes our collective research focus and requires us all to challenge our perspectives on applications of implementation science. Some members hold multiple roles within the National Centre and its activities, while others are external to the Centre. Our inclusion of mental health lived experience perspectives helps address the previous omission of experts by experience in implementation and translation research (8). We reviewed mental health service literature to see how implementation factors are integrated into research and practice, and how these are reported. Many papers focused on different contexts, making a coherent review difficult. Limited reporting hindered a comprehensive summary. However, we found reviews on implementing innovations in mental health services, covering diverse settings and practices. These reviews allowed us to synthesise concepts, lessons, and identify gaps in implementation knowledge globally. This paper summarises these reviews, showing how implementation and translation are applied in mental health research. The field of implementation science encompasses theories, models, and frameworks designed to articulate the various types and layers of influence as innovations are implemented into what the field calls 'real-world’ contexts. Examples of these frameworks include Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (RE-AIM) (9), the Consolidated Framework for Implementation Research (CFIR) (10), and the Promoting Action on Research Implementation in Health Services (PARIHS) Framework (11). To organise and synthesise the findings from this review of reviews, we utilise the updated CFIR 2.0 (5) to structure our understanding of barriers and enablers to innovation implementation in high-income countries. While focusing on high-income countries may overlook some contextual factors, we believe that differences in socio-economic, cultural, political, and healthcare settings would be difficult to translate from low- and middle-income countries. The comprehensive structure of CFIR 2.0, its genesis through a metatheoretical analysis of existing frameworks, and feedback from its application in practice and research influenced our choice (5, 12). The questions guiding the current review were: How are the concepts from implementation and translation science being applied in the reporting of mental health service research and reviews of research evidence? What are the enablers and barriers to implementation of innovative practice that are identified in reviews of mental health service research as articulated through the lens of CFIR 2.0? How has Lived Experience been incorporated into reviews of implementation and translation of research in mental health services? Methods Design This review of reviews employed a systematic approach to identify and map the evidence base and implementation challenges in the literature, thereby highlighting gaps. It was conducted to synthesise systematic reviews published over the past 15 years. Guided by Fusar-Poli & Radua (13), and Gates et al. (14) and our exploratory research questions, our review adopted a charting and theming approach using the CFIR 2.0. The comprehensive structure of CFIR facilitates the synthesis of diverse information in a consistent and efficient way supporting dissemination of key insights to stakeholders (15). Search strategy and inclusion and exclusion criteria Our search was conducted in September 2025 using ProQuest Central, Medline, PsychInfo, and Cochrane. A research librarian from La Trobe University was consulted to help select the databases and appropriate search terms. We focused on peer-reviewed papers published between January 2010 and August 2025. Our search terms (keywords and MeSH terms) reflected three central concepts: “implementation science,” “mental health,” and “mental health services” (full search string available in additional file 1). These terms covered concepts of implementation science, knowledge translation, and improvement science, as well as the various settings where mental health care is provided, including community, inpatient, outpatient, and educational environments. The search was limited to full-text publications in English. Table 1 presents the inclusion and exclusion criteria used to select papers at each stage of the review. Table 1. Inclusion and exclusion criteria Study selection and data extraction Study selection followed agreed inclusion and exclusion criteria (Table 1) and managed using the online software Covidence. Four reviewers participated in the screening process. After removing duplicates (411), each paper was screened by two reviewers at three stages: title (JF, DJ), abstract (JF, DJ, EC), and full text (JF, DJ, DGS). A study advanced to the next stage only if it received two 'yes' votes during both abstract and full-text screening. The project lead (LB) was consulted to resolve any conflicting votes. Using the research questions, a data extraction table and guidance notes were developed to extract relevant data from the reviews. This included: • Article identifiers including the topic, age, and setting of the review. • The reported use of implementation and translation science models, theories, and frameworks. • The specific barriers and enablers related to implementation of the specific model or guideline that was the subject of the review. • Engagement of people with lived experience in any aspect of the review and evidence of involvement of lived experience expertise in conducting the research activity. Quality Appraisal We chose to use the AMSTAR and the CASP to rate the quality of the papers as neither was completely fit for purpose. Initial ratings on both instruments were conducted by JD and reviewed by JF and came to consensus. The papers rated poorly on the AMSTAR because it is more suited systematic reviews with meta-analyses. The CASP more reliably assessed the quality of the papers even though its primary focus is not review papers. The CASP indicated that the quality of papers improved in more recent years, see supplementary material. As this was a scoping review, we included all papers as they contained relevant information pertaining to the research questions. Synthesis of Findings The CFIR 2.0 provides a framework for organising and synthesising the findings of this review. The CFIR is a meta-theoretical framework comprising five domains (one of which has two subdomains), encompassing 48 constructs and 19 subconstructs, as outlined in Table 2 (5). The CFIR has been utilised in numerous studies of complex mental health services (Gilmer et al., 2013; Fletcher et al., 2021; Brook et al., 2018). A key benefit of the CFIR is that it helps us understand the barriers and enablers of implementing an innovation, as well as providing insight into why and how various processes work (5). [TABLE 2 ABOUT HERE] Data were extracted from each review paper using the CFIR domains and constructs. Extracted data were labelled either as a barrier, enabler, or a combination of both. Data extraction was completed by JF and checked by JD. These results are presented as a summary table and narrative synthesis. Findings Literature Search Tweleve reviews met the inclusion criteria. The Prisma diagram in Figure 1 shows the progress of screening the papers and reasons for exclusion. Figure 1: PRISMA diagram All reviews included were described by the authors as systematic reviews (see Table 3). The number of papers reviewed in each study ranged from 12 to 77. Their populations varied, with some not specified and others focused on age groups such as children and youth. The reviews included in this review of reviews concentrated on one or more of the following settings: inpatient, outpatient, community, non-government organisations, education, and primary care. The topics of the reviews were diverse, but all had an implementation focus for mental health. [Table 3 about here] Application of implementation and translation science to mental health research and practice. Ten of the reviews reported using at least one theory or framework to guide their analysis, with three reporting the use of two or three theories or frameworks (Table 4). The CFIR was utilised by six of the reviews, while the PARIHS framework was employed by three reviews. Other frameworks or theories included the National Implementation Research Network (NIRN), the Knowledge to Action Process (KT Framework), the Proctor Model, the Exploration, Planning, Implementation, and Sustainment (EPIS) Framework, and the RE-AIM Framework. [Table 4 about here] Enablers and barriers of implementation identified in the literature All but one review identified enablers of implementation, including staff training, processes, leadership involvement, staff relationships, and innovation flexibility. Nine review papers listed barriers to implementation, such as lack of local adaptation, staff attitudes, perceived incompatibility of the intervention, and inappropriate organisational structures (see Table 4). A detailed synthesis of the barriers and enablers is presented in Table 5, framed using CFIR constructs. [Table 5 about here] Findings from each review paper that indicated influence on the implementation of innovations were mapped to CFIR domains and related constructs. The influence was coded as ‘barrier,’ ‘enabler,’ ‘impact not determined’ (findings reported without establishing the impact on implementation), ‘both enabler and barrier,’ ‘impact not determined and barrier,’ or ‘impact not determined and enabler’ see Table 5 (16). Four review papers reported findings related to each of the five CFIR domains (16-19). The inner setting domain was the only one included in all reviews. The number of constructs reported across reviews varied considerably. The following synthesis details which CFIR domains and constructs appear in reviews focused on the implementation of innovations in mental health services and their impacts on implementation. Innovation Domain Six reviews reported findings in the Innovation Domain, with each review addressing one to five of the eight constructs in this domain. When included, they enabled implementation. The Innovation Source was highlighted in one review, which found that when people with lived experience promoted the use of a specific recovery-oriented model, this enabled implementation. Piat et al. (20) also reported that recovery-oriented innovation by design included relationship-building among clinical staff, peer and family workers, and those receiving services. Innovations were seen to have a Relative Advantage over standard care when there was a focus on staff-patient relationship (18, 20), when there were perceived benefits to patients relating to experience of care, cost effectiveness and better symptom management (19). In contrast, Appleton et al. (2021) reviewed tele-mental health and reported mixed views regarding the Relative Advantage of implementing it. For those in remote locations, accessing care became more straightforward and less costly, but in contrast, clinicians felt that care was compromised due to a lack of non-verbal cues to support reliable assessment of mental health status. Innovation Adaptability was reported across seven reviews, and the type of adaptation varied according to the innovation, such as the delivery mode (individual or group, in-person or remote). In the Piat et al. (20) review on recovery, flexibility related to the personnel delivering interventions and adapting the intervention to local context, for example, forensic units (18) and individual need (17). In contrast, innovations that were highly manualised and lacked flexibility faced barriers to implementation ((16, 17, 19). Piat et al. (20) also identified that a barrier to implementing recovery-oriented practice was the relational complexity required of staff who were not yet comfortable with the recovery model (Innovation Complexity ). In contrast, Innovation Design , such as including people with lived experience in the design of recovery-oriented innovations, was viewed by many as an advantage and enabler. (19), also highlight that the Innovation Cost of team-based functions and infrastructure for the collaborative care model was a barrier in a service system that only accepted individual clinician visits in the payment structure. Outer Setting Domain Nine reviews identified findings within the Outer Setting Domain, which included one to four of this domain’s 10 constructs and subconstructs per review. The few constructs highlighted were mainly found to facilitate implementation. The Outer Setting Domain is rarely considered in research and evaluation of innovations. However, this domain was in focus when innovations were delivered across systems or countries, such as tele-mental health services during the COVID-19 lockdowns, Veterans Health Administration policy shifts in the USA, or legislation to implement the IPS model. In the Covid-19 case, a Critical Incident acted as the catalyst for change, with Local Conditions in the USA, such as health insurance funding, enabling access to telehealth services for some while acting as a barrier for those without adequate health coverage. In some countries, the impact of network capacity was actively considered, leading to the development of guidelines to assist clinicians in using telehealth, supported by various professional bodies. The review by Rosen et al. highlighted Local Attitudes , such as strong political and public interest, as an Outer Setting domain supporting the shift towards more suitable therapy options for Veterans. Veterans' Health Administration (VHA) Policies mandating specific evidence-based therapies across all VHA clinics and extending Partnerships and Connections through external training consultants also acted as enablers. Table 6 illustrates the variety of settings and the distinct ways the outer setting influenced implementation. Inner Setting Domain All reviews reported findings classified within the Inner Setting Domain, which covered between one and nine of 21 constructs and subconstructs per review. Constructs within this domain were both barriers and enablers to implementation success. Various Structural Characteristics influenced implementation; for example, a change in Physical Infrastructure was reported as an enabler in two reviews (21, 25). However, outcomes regarding the impact of Work Infrastructure varied more widely. Being understaffed or unable to attractor retain suitable staff, or lack of protected time, was often a barrier to successful implementation ((17-19). Conversely, strategic changes to work practices that supported new models of care, along with staff training, enabled successful implementation (26). Strong and positive Relational Connections enabled implementation by providing team members with important emotional support, respect, and mutual esteem (16, 20). Paradoxically, strong team cohesion could also be a barrier to implementation when an innovation was not favoured by the team (16). In workplaces where new roles were being established, challenging relationships between clinicians and peer support workers acted as a barrier to implementation (20). Linked to challenges in Relational Connections, a dominant Culture that prioritised the traditional biomedical model was a barrier to implementation of recovery-oriented practice (20). Furthermore, the extent to which the organisation's Culture was perceived as Recipient-Centred posed a barrier to implementation. For example, in the Lorien et al. review, staff attitudes regarding the value of a recovery approach for service users influenced their willingness to implement recovery-oriented practice in inpatient settings (26). Harkko et al reported that the organisation's Culture could support implementation when staff attitudes and beliefs aligned with the IPS model and were a barrier when staff reported that IPS was at odds with the organisation's principles of care (23). Piat et al. also reported that a Culture of Learning Centredness that emphasised the biomedical approach hindered the shift to a recovery-oriented approach (20). Conversely, the use of case and practice-level data for teams and individual clinicians highlighted that a Culture of Learning Centredness on this data was an enabler of implementation (24, 25). In organisations where the innovation was given Relative Priority, implementation was enabled. Indications of priority included policy changes, communication of support from executives and leaders, amending organisational policies, procedures, record keeping, and staffing. These measures often led to Mission Alignment, which supported implementation) (16, 24, 25). Additionally, some innovations were seen to align with existing organisational priorities, for example, person-centred care (18). In contrast, where incompatible practices continued to be prioritised, the Relative Priority of older practices created a barrier to implementing new innovations. A failure to prioritise recovery compromised Mission Alignment (17, 23, 26). For example, work practices, including the allocation of staff time to talk with consumers, were not adjusted to support implementation (26). Access to Knowledge and Information, specifically training, was the construct with the most data collected from the included reviews. Training that is specific and interactive, involving all relevant professions, using a variety of practical strategies to practise new skills, ask questions, and receive feedback, enabled implementation. However, in some reviews, despite the availability of appropriate training, barriers to implementation were identified, such as insufficient numbers of staff being trained or trouble retaining trained staff (18). Lorien et al. noted that increased knowledge does not always lead to practice change, and Piat et al. (20) reported incomplete knowledge despite training. Access for staff to Available Resources, such as centralised training at no cost to the organisation and external support, were both enablers of implementation (for example, Harkko et al.) (23). Similarly, internal infrastructure that provided staff with the time and resources for training supported implementation. Individuals Domain (Roles subdomain & Characteristics subdomain) Ten reviews reported findings classified into the Individuals Domain, which covered between one and four of this domain’s thirteen constructs and subconstructs per review. Constructs in the Individuals domain were more frequently reported as barriers to implementation. In some cases, Innovation Recipients posed a barrier to implementation when they did not believe the proposed innovation would be effective (16). In the reviewed papers, High-level Leaders played an important role in innovation implementation. Their positive support was an enabler (24, 25), and their lack of support was a barrier (26). Bryson et al., 2017 also mentioned Innovation Deliverers and the positive impact their support for trauma-informed care had on its implementation. In contrast, Björkdahl et al. reported that ward-level managers were not supportive of Safewards if they had not been involved in the decision and planning (18). The perception that an innovation will meet the Needs of consumers was reported to impact the degree to which High-Level Leaders supported the innovation, and the degree to which Innovation Deliverers would utilise an innovation in place of current practice (16, 20, 21). However, Innovation Deliverers were not supportive of implementation if they did not believe the target group had the required capability to utilise IPS (23). Furthermore, successful implementation of the innovation was impacted by the Capability of Innovation Deliverers (20, 21). In contrast, psychiatrists who did not receive additional training regarding consultation to primary care felt they lacked the capability to be part of the collaborative care model (19). Finally, one review noted that Innovation Deliverers were not given Opportunity in terms of time and resources, and this was a barrier to implementation (25). Implementation Process Domain Nine of the twelve reviews identified findings related to the Implementation Process Domain, which covered between one and three of this Domain’s fifteen constructs and subconstructs per review. Evidence that Planning enabled implementation included documented guidance (16), the establishment of new workflows (21), and the pre-determination of mitigation strategies for potential implementation challenges (20). Conversely, a lack of Planning , such as absent or inadequate protocols, guidelines, clear role definitions, and training, created barriers (20). Tailoring Strategies to support implementation, such as Communities of Practice (27) and training methods aligned to the innovation like shadowing and clinical discussions (21), were reported as enablers. Engaging of a range of stakeholders early in the process was an enabler (20). Early Engagement of Innovation Deliverers acted as an enabler, but its absence served as a barrier (20). The same pattern was observed when engaging Innovation Recipients (21, 25, 26), for example, staff were reminded of the importance of Safewards due to active patient engagement (18). Reflecting and Evaluating about the Implementation and Innovation allowed staff to review data, which motivated continued implementation (25). Conversely, when an impact was not observed or communicated to staff, it became a barrier. Other models in use in the literature In the update of the CFIR, authors highlighted the lack of specific focus on outcomes and advocated the use of the Proctor Taxonomy to deepen understanding regarding implementation outcomes (5). However, only one paper in the review applied the Proctor taxonomy and the CFIR to measure implementation outcomes and described the degree of implementation success according to the categories outlined by the Proctor taxonomy (21). The Proctor taxonomy is useful because it provides a common language that outlines crucial aspects of evaluation, ensuring all stakeholders understand what matters. This model enhances and provides depth to the Reflecting and Evaluating domains of the CFIR, emphasising the importance of clearly defining evaluation criteria to understand the effectiveness of an intervention Using the Proctor taxonomy, Appleton et al. (21) concluded that the studies showed that greater emphasis was placed on the outcomes of Acceptability and Adoption , with high levels of acceptance and uptake among both service users and providers being valued. Feasibility was also important, highlighting the practicality of implementing telemental health . Cost and Penetration were less emphasized but still relevant in assessing the overall impact and reach of the programs. No studies explored Fidelity in the context of implementation outcomes. Lived Experience inclusion and involvement as found in the literature Six reviews mentioned the involvement of people with lived experience (20, 21, 24-26).The two reviews regarding recovery-oriented practice (20, 26), the review of implementing trauma-informed care (25) and the review of Safewards (18), concerned models of care that are designed specifically to value and include people with lived experience as experts. Table 7 presents a summary of how the reviewed papers described lived experience involvement and its impact. Bryon (25) highlighted the positive impact that involving lived experience had on successful implementation; however, they added that most papers reporting implementation of trauma-informed care did not involve people with lived experience and their families. The reviews of Lorien et al. (26) and Piat et al. (20) both state that people with lived experience were involved in various ways including storytelling for clinical staff training and being employed as peer workers. However, there was an absence of people with lived experience being included in a genuine co-design capacity (21, 24). Two other papers only addressed the need for input from lived experience after the review was finished. In their review of knowledge translation for mental health practitioners, Goldner et al.(24) conclude that, in addition to traditional learning methods, practitioners could also learn from people with lived experience and their family members. In the review by Appleton et al.(21) there is a lived experience perspective commentary that highlights the fact that the 77 papers reviewed did not incorporate participatory research approaches, even though it is now widely recognised that this is a crucial element of high-quality research. Furthermore, the commentary states that the review itself was conducted without involving people with lived experience. Discussion This review of reviews analysed published reviews over the past 15 years of efforts to implement innovations in mental health practice to understand how implementation science concepts are adopted and reported in mental health research. As members of a diverse network of researchers, service providers, and individuals with lived experience, we aimed to identify which implementation strategies promoted innovation and to better understand the barriers and enablers to evidence-based implementation in this field. An additional question explored whether and how lived experience perspectives were involved in generating, translating, and implementing evidence in mental health services. Lived experience involvement in the reviews was limited despite recognition of its importance ( 28 , 29 ). Of the reviews that mentioned lived experience involvement ( 20 , 25 , 26 ), all acknowledged that most of the papers they examined did not involve people with lived experience or their families, and none mentioned involving lived experience experts in conducting or reporting their reviews. A lived experience commentary in the Appleton et al. ( 21 ) paper argued that lived experience involvement is integral to ensure that no aspect of the research is missed, misunderstood, or skewed. As a group, we reflected that without meaningful involvement of this critical perspective in all phases of implementation research, gaps will continue to affect the recipients of innovation (as described by the CFIR- Individual domain, role subdomain I). We observed that the numerous domains within CFIR may overshadow or diminish the critical importance of innovation recipients, and that the lived experience lens is needed across many CFIR domains. We found little to no reflection on the use of implementation and translation science in the individual research papers reviewed. Each review paper focused on the implementation of a specific practice innovation by examining a group of published studies, but it was the review papers themselves that introduced and used a framework to organise and report findings. Piat et al. ( 20 ) highlighted the difficulty of identifying what constitutes an implementation study, especially when there was minimal reference to an implementation framework. In their critical review of e-mental health approaches for depression and anxiety, Ellis and colleagues ( 30 ) emphasised the lack of application of implementation science in most studies. They strongly advocated for using frameworks to guide the collection of implementation data and to understand factors influencing real-world implementation. They also supported mixed-methods research as the best approach for gaining a deep understanding of implementation successes and failures. The review papers included in this current synthesis of reviews commonly concluded that implementing practice change and scaling up innovations is complex ( 27 ), and the barriers to successful implementation are specific to context and setting ( 22 ). Recognising that practice change is challenging and multifaceted is valuable because simpler interpretations tend to obscure or overlook the complexity, undermining efforts to adopt or sustain changes. We decided to use the revised and increasingly utilised CFIR to structure our analysis but recognise that this framework has both strengths and limitations. Like Ellis ( 30 ), we appreciated how CFIR helped us better understand the range of factors involved in implementation, demonstrating the value of structured implementation frameworks. The various factors considered by CFIR, including inner and outer settings, the individuals involved, and the innovation itself, allowed us to adopt a comprehensive approach to many elements we found important from our different perspectives working across diverse regions and communities. However, we remain aware that the theoretical basis of CFIR is not universally accepted within the evolving field of implementation science and that not all perspectives have had opportunity to influence this framework. We agree that curiosity about the still-missing elements within CFIR is necessary. Our review highlighted the complex interplay between the five CFIR domains in efforts to implement innovations. Our findings suggest that the constructs in the Innovation Domain may be the initial positive drivers of successful implementation, as demonstrated by Piat et al. ( 20 ). The source, design, perceived relative advantage, and adaptability all contributed to enabling the implementation of recovery-oriented practice. Veldmeijer and colleagues ( 31 ), also found lived experience perspectives in the design of innovations is critical. The Outer Setting domain also enabled implementation in various ways, but its impact was highly specific to the innovation and the implementation context. Implementers need to consider social, political, and economic factors beyond the inner implementation context to foster successful innovation and remain alert to the outer setting factors fostering success in one setting and hindering it in another ( 5 ). We observed significant attention to, and variability within, the Inner Setting Domain, likely because this domain considers the specific culture of the organisation where implementation takes place, raising researcher awareness of local factors affecting the process. Similarly, findings related to the Individuals Domain are often more evident to researchers, who can observe and sometimes measure staff and organisational leaders' attitudes. The findings we could link to the Implementation Process Domain highlight the lack of thorough and careful planning in research implementation. However, our findings show that implementation success improves when strategies are tailored and when engagement of those -involved is prioritised. This aligns with other studies that use implementation frameworks to plan for successful implementation. Authors King et al. ( 32 ) and Roshan et al. ( 33 ) argue that research teams need to take time to identify relevant domains that are likely to influence the adoption, implementation, and maintenance of an intervention. These domains can be used to tailor implementation strategies and to guide regular monitoring of impact, as well as the quick identification of emerging implementation challenges. The papers on recovery orientation offer a clear example of the complex, interconnected relationships among the CFIR constructs. Implementing recovery-oriented practices represented a significant shift in thinking and practice for organisations and staff accustomed to, or preferring, a biomedical approach. This explained low engagement in training, limited individual staff motivation, and unadjusted work practices that did not support the innovation. While reports on the challenges of implementing recovery-oriented practice worldwide are common ( 34 , 35 ), these findings clarify the types of implementation strategies that require attention to improve real-world implementation success. Knowledge Translation was the only approach commonly discussed across multiple papers in our review; however, Knowledge Translation is only one part of a comprehensive implementation strategy, and relying solely on this strategy may be insufficient to bring about practice change ( 27 , 36 ). For knowledge translation strategies to work effectively, local context requires consideration, and organisational barriers must be addressed ( 24 ). Efforts in knowledge translation primarily focused on staff training, despite research rarely measuring or presenting convincing evidence of training’s impact on knowledge and skill acquisition ( 16 ). Intervention fidelity and clinician behaviour change that leads to practice change cannot depend on staff training alone ( 16 , 27 ). Well-designed training based on adult learning principles, which is clearly reported, may improve the quality of training and, in turn, its impact ( 37 ). In this review of systematic reviews, the measurement of implementation success has been inconsistent, often relying on data that is convenient and readily available rather than fit for purpose. The CFIR’s lack of emphasis on clearly defined implementation outcomes is a limitation of the framework. The Proctor Model offers a comprehensive way to measure and report implementation outcomes, and Damschroder et al ( 5 ) have promoted its use in the update to the CFIR. Appleton et al. ( 21 ) successfully employed the Proctor Model to synthesise the outcomes of the studies they reviewed, noting that outcomes related to acceptability, adoption, and feasibility were most frequently reported, but fidelity was not reported at all. Other missing elements concern issues of equity and power. As we have indicated, further incorporating lived experience perspectives is a vital step in addressing this gap. Conclusions To see the promises of reform and improved outcomes for people accessing mental health services, attention needs to be paid to implementing research findings in real-world settings. Our review shows that implementing innovations is complex, and few research efforts acknowledge or report this complexity. Frameworks like CFIR are detailed, but researchers could improve the translation process by engaging with the diverse domains and constructs throughout a project, as these can offer a deeper understanding of potential barriers and enablers. During planning, selective focus on the most relevant domains and constructs for the innovation and specific context is required, but this focus should flex as challenges arise throughout implementation. Remaining open and curious about factors not covered in CFIR is also important, as is choosing frameworks that suit the issue at hand. This paper aims to highlight the challenges associated with implementing mental health interventions in real-world contexts. We emphasise that, although lived experience perspectives are considered valuable for implementation, their inclusion is not yet common practice. Additionally, we agree with Chambers and Emmons ( 38 ) that raising awareness of this issue should encourage prioritising implementation science in research design, allowing the field to mature and grow. Declarations Ethics approval and consent to participate: Not applicable Consent for publication: Not applicable Availability of data and materials: All data generated are available in the manuscript or in the supplementary material Competing interests: The authors declare no competing interests Funding: This project was supported by the ALIVE National Research Translation Centre for Mental Health through the National Health and Medical Research Council (NHMRC) Special Initiative in Mental Health (grant number APP2002047) Authors' contributions JF: Conceptualization, Methodology, Formal Analysis, Investigation, Data Curation, Writing – Original Draft, Writing – Review & Editing, Visualization, Supervision PE: Conceptualization, Methodology, Formal Analysis, Investigation, Writing – Original Draft, Writing – Review & Editing DS: Methodology, Formal Analysis, Investigation, Data Curation, Writing – Original Draft, Writing – Review & Editing JN: Investigation, Data Curation, Writing – Original Draft, Writing – Review & Editing. DJ: Conceptualization, Methodology, Writing – Review & Editing HP: Conceptualization, Writing – Original Draft, Writing – Review & Editing EC: Conceptualization, Methodology VP: Conceptualization, Methodology, Writing – Review & Editing, Supervision LB: Conceptualization, Methodology, Formal Analysis, Investigation, Data Curation, Writing – Original Draft, Writing – Review & Editing, Supervision, Project Administration All authors reviewed the manuscript Acknowledgements: The authors wish to acknowledge the Implementation & Translation Network – The Alive National Centre for their expertise and input into this work References Killaspy H, Harvey C, Brasier C, Brophy L, Ennals P, Fletcher J, et al. Community‐based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence. World psychiatry. 2022;21(1):96-123. Harvey C, Zirnsak T-M, Brasier C, Ennals P, Fletcher J, Hamilton B, et al. Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis. Frontiers in psychiatry. 2023;14:1259944. Palmer VJ, Wheeler AJ, Jazayeri D, Gulliver A, Hegarty K, Moorhouse J, et al. Lost in translation: a narrative review and synthesis of the published international literature on mental health research and translation priorities (2011-2023). J Ment Health. 2024;33(5):674-90. Banfield M, Palmer VJ. Embedding lived experience in mental health research: what we need to pack (and unpack) for the future in mental health research and translation. BMJ open. 2025;15(5):e098557. Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implementation science : IS. 2022;17(1):75-16. Robinson T, Bailey C, Morris H, Burns P, Melder A, Croft C, et al. Bridging the research–practice gap in healthcare: a rapid review of research translation centres in England and Australia. Health research policy and systems. 2020;18(1):1-17. Younas A. Potential Factors Contributing to and Strategies for Reducing Implementation Science-Practice Gap: A Discussion. Global implementation research and applications. 2024;4(3):361- Druss BG, Jones N. Evidence-Based Practicing in Mental Health. JAMA psychiatry (Chicago, Ill). 2025;82(5):433-4. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American journal of public health (1971). 1999;89(9):1322-7. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation science : IS. 2009;4(1):50-. Rycroft-Malone J. The PARIHS Framework—A Framework for Guiding the Implementation of Evidence-based Practice. Journal of nursing care quality. 2004;19(4):297-304. Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the Consolidated Framework for Implementation Research. Implementation science : IS. 2016;11(1):72. Fusar-Poli P, Radua J. Ten simple rules for conducting umbrella reviews. BMJ mental health. 2018;21(3):95-100. Gates M, Gates A, Guitard S, Pollock M, Hartling L. Guidance for overviews of reviews continues to accumulate, but important challenges remain: a scoping review. Systematic reviews. 2020;9(1):254-. Kirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the Consolidated Framework for Implementation Research. Implementation science : IS. 2016;11(1):72-. Rosen CS, Matthieu MM, Wiltsey Stirman S, Cook JM, Landes S, Bernardy NC, et al. A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration. Administration and policy in mental health and mental health services research. 2016;43(6):957-77. Ahmed H, Bendall C, Anwar F, Al‐Janabi M, Wood L. A Systematic Review and Narrative Synthesis Examining the Facilitators and Barriers of Psychological Intervention Delivery in Crisis Resolution Home Treatment Teams. Clinical psychology and psychotherapy. 2024;31(4):e3032-n/a. Björkdahl A, Johansson U, Kjellin L, Pelto‐Piri V. Barriers and enablers to the implementation of Safewards and the alignment to the i‐PARIHS framework – A qualitative systematic review. International journal of mental health nursing. 2024;33(1):18-36. Mauer-Vakil D, Sunderji N, Webb D, Rudoler D, Allin S. Approaches to Integrate Mental Health Services in Primary Care: A Scoping Review of System-Level Barriers and Enablers to Implementation. Canadian Journal of Community Mental Health. 2023;42(3):29-45. Piat M, Wainwright M, Sofouli E, Vachon B, Deslauriers T, Préfontaine C, et al. Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review. Systematic reviews. 2021;10(1):134-. Appleton R, Williams J, Juan NVS, Needle JJ, Schlief M, Jordan H, et al. Implementation, Adoption, and Perceptions of Telemental Health during the COVID-19 Pandemic: Systematic Review. Journal of medical Internet research. 2021;23(12):e31746-e. Girlanda F, Fiedler I, Ay E, Barbui C, Koesters M. Guideline implementation strategies for specialist mental healthcare. Current opinion in psychiatry. 2013;26(4):369-75. Harkko J, Sipilä N, Nordquist H, Lallukka T, Appelqvist-Schmidlechner K, Donnelly M, et al. External context in individual placement and support implementation: a scoping review with abductive thematic analysis. Implementation science : IS. 2023;18(1):61-23. Goldner EM, Jenkins EK, Fischer B. A Narrative Review of Recent Developments in Knowledge Translation and Implications for Mental Health Care Providers. Canadian journal of psychiatry. 2014;59(3):160-9. Bryson SA, Gauvin E, Jamieson A, Rathgeber M, Faulkner-Gibson L, Bell S, et al. What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. International journal of mental health systems. 2017;11(1):36-. Lorien L, Blunden S, Madsen W. Implementation of recovery‐oriented practice in hospital‐based mental health services: A systematic review. International journal of mental health nursing. 2020;29(6):1035-48. Barwick MA, Schachter HM, Bennett LM, McGowan J, Ly M, Wilson A, et al. Knowledge Translation Efforts in Child and Youth Mental Health: A Systematic Review. Journal of evidence-based social work. 2012;9(4):369-95. Sartor C. Mental health and lived experience: The value of lived experience expertise in global mental health. Global mental health. 2023;10:e38-e. Sunkel C, Sartor C. Perspectives: involving persons with lived experience of mental health conditions in service delivery, development and leadership. BJPsych Bulletin. 2022;46(3):160-4. Ellis LA, Augustsson H, Grødahl AI, Pomare C, Churruca K, Long JC, et al. Implementation of e‐mental health for depression and anxiety: A critical scoping review. Journal of community psychology. 2020;48(3):904-20. Veldmeijer L, Terlouw G, Van Os J, Van Dijk O, Van 't Veer J, Boonstra N. The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review. JMIR mental health. 2023;10:e46590. King DK, Shoup JA, Raebel MA, Anderson CB, Wagner NM, Ritzwoller DP, et al. Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study. Frontiers in public health. 2020;8:59-. Roshan R, Hamid S, Kumar R, Hamdani U, Naqvi S, Zill e H, et al. Utilizing the CFIR framework for mapping the facilitators and barriers of implementing teachers led school mental health programs – a scoping review. Social Psychiatry and Psychiatric Epidemiology. 2025;60(3):535-48. Chatwiriyaphong R, Moxham L, Bosworth R, Kinghorn G. The experience of healthcare professionals implementing recovery‐oriented practice in mental health inpatient units: A qualitative evidence synthesis. Journal of psychiatric and mental health nursing. 2024;31(3):287-302. Martinelli A. An overview of mental health recovery-oriented practices: potentiality, challenges, prejudices, and misunderstandings. Journal of Psychopathology. 2020;26(2):147. Curtis K, Fry M, Shaban RZ, Considine J. Translating research findings to clinical nursing practice. Journal of clinical nursing. 2017;26(5-6):862-72. Jolliffe L, Lannin NA, Larcombe S, Major B, Hoffmann T, Lynch E. Training and education provided to local change champions within implementation trials: a rapid systematic review. Implementation science : IS. 2025;20(1):8-40. Chambers DA, Emmons KM. Navigating the field of implementation science towards maturity: challenges and opportunities. Implementation science : IS. 2024;19(1):26-. Tables Table 1. Inclusion and exclusion criteria Inclusion criteria Exclusion criteria Mental Health related reviews conducted between 2010 and 2025, anywhere in the world in English Reviews that primarily report on implementation (strategies used, enablers, barriers, implementation data, fidelity organisational culture/characteristics) Reviews that have purposefully collected data to answer implementation questions about implementation of practice innovation in a service context Reviews that have used data collection to inform implementation and translation questions Reviews of mental health focused studies that report on translation and/or scalability Reviews that consider the mental health service setting/context Reviews conducted in low- and middle-income countries Protocol papers, editorials, commentaries, and opinion pieces Papers not in English Reviews only including implementation of measures, health record data collection, software Reviews of reviews without implementation data (for example classic RCTs) Reviews involving medication only Reviews with a population related to intellectual disabilities and developmental disorders Reviews primarily related to a medical condition such as HIV, Cancer etc with mental health consequences for family or others Table 6. Outer Setting Domain examples of findings Construct Review Paper Topic Example A. Critical Incidents Covid-19 telemental health Appleton et al. (21) reported that Covid-19 lockdowns resulted in Treatment as Usual being shifted to remote ways of working B. Local Attitudes Veterans Mental Health in USA Rosen et al. (16) reported strong political attention to help Veterans and improve the care they receive Psychological Intervention Delivery Ahmed et al. (17) highlighted that valuing the social system within CRHTTs and including family therapies supported implementation C. Local Conditions Covid-19 telemental health Appleton et al. (21) reported that health cover for telemental health varied across the USA, so was both an enabler and barrier, while in Europe it was covered for the first wave of Covid-19. Platform developers worked to increase network capacity and professional bodies posted supporting guidelines on their websites. One challenge was concerns about video tools having a lack of adherence to strict privacy policies that bind mental health professionals Collaborative primary mental health care Mauer-Vakil et al. (19), highlighted that in small communities, the lack of psychiatrists and family physicians meant that integration of collaborative care was not achieved. D. Partnerships & Connections Veterans Mental Health in USA Implementation of Cognitive Processing Therapy and Prolonged Exposure Therapy was enabled by trained clinicians being supported over the longer term (one year plus) by training consultants with patient. Support was tailored to the individual clinician and focus on the therapy being implemented (16) Guideline Implementation Girlanda et al. (22) mentioned educational outreach visits Individual placement and support Harkko et al. (23) reported that national, state and regional organisations that provide support, training and technical assistance facilitated implementation and sustainment of the IPS model Collaborative primary mental health care Mauer-Vakil et al. (19) reported implementation success in part due to participation in a national collaborative network. E. Policies & Laws Veterans Mental Health in USA Rosen et al. reported two National Policies and the Veterans Health Administration (VHA) policy that support the implementation of Trauma-Informed therapies, and providing almost ideal policy and organisational leadership conditions for successful implementation (16) Knowledge Translation (KT) In Goldner et al., Knowledge Translation emphasises the value of policy and law in providing the framework for system change and policy to guide practice (24) Recovery-oriented practice Piat et al. reported how funders who did not support roles required for an innovation, for example peer worker roles, were a barrier to implementation of recovery-oriented practice (20) Individual placement and support Harkko et al. found competing legislation. Legislation mandating the use of IPS facilitated implementation; however, some social insurance criteria meant that some clients were excluded from IPS (23) Safewards Björkdahl et al reported that legislation, government sponsorship and regulatory frameworks supported the implementation of Safewards in a number of countries (18) Collaborative primary mental health care Mauer-Vakil et al report that in Canada, the existing complexity of billing procedures, licensing and credentialing rules about who can deliver services, and rules about physical and mental health services being billed on the same day, all acted as barriers to the implementation of collaborative care (19) F. Financing Individual placement and support Harkko et al reported that in the Netherlands and Canada, direct funding schemes from government or health ministries facilitated uptake of IPS. Whilst funding specific to medical diagnosis, or divided funding sources were barriers to the uptake of IPS (23) Collaborative primary mental health care Mauer-Vakil et al. 2025 noted lack of funding for mental health workers in primary care via the same system as general practitioners was a barrier to implementing and sustaining collaborative care (19) G. External Pressure Knowledge Translation (KT) Goldner et al. discusses the utility of mass media campaigns to educate the public about innovations, but these may also serve to provide motivation to organisations to deliver evidence-based services. They also discuss the value of community mobilisation (24) Individual placement and support Harkko et al. reported IPS implementation was facilitated when researchers partnered with policy makers and implementing organisations to promote uptake and training (23) Table 7. Reported Lived Experience Involvement Paper Lived Experience Involvement Björkdahl et al. (18) Lived experience was acknowledged as an important enabler in the implementation of Safewards. The study highlighted how patient involvement, particularly through sharing personal experiences, helped staff better understand the relevance and impact of the Safewards interventions. Inclusion of lived experience was seen as enhancing staff engagement and encouraged staff to be more involved and support recovery focused care. Patient involvement was viewed as an enabler of implementation by strengthening collaboration and helping staff use the interventions more regularly. Positive patient feedback motivated staff, whereas limited patient involvement was identified as a barrier to adoption Bryson et al. (25) When community inclusion was discussed, staff are supported through training, coaching, supervision, debriefing, and self-care. Patients and families are consulted and included in their own care plans and in staff training to help staff understand patient and family experiences especially when patients spoke directly to staff about their lived experience Lorien et al. (26) Consumers shared their lived experience story as a way of training staff in recovery-oriented practice. One study collected concurrent measures of consumer perception of recovery-oriented staff behaviours. One study where consumers shared their personal recovery stories did increase staff hope in recovery. Staff working in hospital-based mental health services see consumers when they are in crisis. Therefore, having consumers share their stories of recovery post-discharge, may be pivotal in changing staff attitudes to be more optimistic about recovery for service users Piat et al. (20) Lived experience across innovations, the inclusion of people with lived experience of mental health challenges was a valued aspect of designing and packaging recovery-oriented innovations. When the source of the intervention was a person or group of people with lived experience, this was viewed positively. Those with lived experience were perceived to have a relative advantage over other staff when it came to working in a recovery-oriented way Additional Declarations No competing interests reported. Supplementary Files CASPchecklist.docx AMSTARchecklist.docx PRIORchecklist.docx AdditionalFiles.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 01 May, 2026 Reviews received at journal 29 Apr, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 12 Apr, 2026 Reviewers invited by journal 10 Apr, 2026 Editor assigned by journal 06 Apr, 2026 Submission checks completed at journal 23 Mar, 2026 First submitted to journal 22 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9193899","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":624997309,"identity":"26d98097-83de-4a39-af2a-454d59e47a2f","order_by":0,"name":"Justine Fletcher","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABO0lEQVRIie3QsUrDQBgH8AuBZDnI+rnYV7gQKBWDvkpCoVmudSiIQ4eTwHWxzvExXErH6EFc8gAZ08mlQ4sgdGn9ripC0+wO94fcXb7w45+EEBOTfxhL4BLh5U5/7jzcc0J6eshaiCX0U6rwoMmZOBBoJb9Ff4Tlh2k7sbPkvV4uQkJt+63eLsKboBq+vFZ3MCJuOgcyUY2KjPsiLgdInPh+Vg4u5tUoUryEMaHFLZDiFLFELBW5tqmfWlKxbsWZGkqIBfAuEOcESZZI9tjibZDsWZBpskPSWSHZnSARvpjMkVALSc4YaCJ0C+0C9jbIw8rPYtmn+C3+00z2GZQrpngBY4cOxr34MTkm/jSpN1t5dU7dtF7jgXlTHnzwSTjyXPVcrT8vG0R877T5/x29RM15pzkyMTExMTnKF+Igb/5CWdZXAAAAAElFTkSuQmCC","orcid":"","institution":"University of Melbourne","correspondingAuthor":true,"prefix":"","firstName":"Justine","middleName":"","lastName":"Fletcher","suffix":""},{"id":624997310,"identity":"95d4f2da-b3e6-456d-b667-42f3717e1dca","order_by":1,"name":"Pricilla Ennals","email":"","orcid":"","institution":"Neami National","correspondingAuthor":false,"prefix":"","firstName":"Pricilla","middleName":"","lastName":"Ennals","suffix":""},{"id":624997311,"identity":"d5ea3f85-8096-4e48-b653-b9b1cc187bc9","order_by":2,"name":"Dianna G Smith","email":"","orcid":"","institution":"Australian National University","correspondingAuthor":false,"prefix":"","firstName":"Dianna","middleName":"G","lastName":"Smith","suffix":""},{"id":624997312,"identity":"47f2b279-b78d-49b4-b0f7-20afd7ac18de","order_by":3,"name":"Julia De Nicola","email":"","orcid":"","institution":"La Trobe University","correspondingAuthor":false,"prefix":"","firstName":"Julia","middleName":"","lastName":"De Nicola","suffix":""},{"id":624997313,"identity":"75a9f57d-3eb5-4455-98e7-9b43fea07214","order_by":4,"name":"Dana Jazayeri","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Dana","middleName":"","lastName":"Jazayeri","suffix":""},{"id":624997314,"identity":"3e00b0c1-f159-4948-bfe1-020f52b987c3","order_by":5,"name":"Hayley Purdon","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Hayley","middleName":"","lastName":"Purdon","suffix":""},{"id":624997315,"identity":"84affd55-cd98-4de9-a377-f7a670f4b7a9","order_by":6,"name":"Elise Carrotte","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Elise","middleName":"","lastName":"Carrotte","suffix":""},{"id":624997316,"identity":"6d8dc680-8fe5-41a9-b10b-f21026ee9949","order_by":7,"name":"Victoria J Palmer","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Victoria","middleName":"J","lastName":"Palmer","suffix":""},{"id":624997317,"identity":"66e69f9d-5352-4efc-8961-78b6b95f939c","order_by":8,"name":"Lisa Brophy","email":"","orcid":"","institution":"La Trobe University","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Brophy","suffix":""}],"badges":[],"createdAt":"2026-03-22 22:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9193899/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9193899/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107485865,"identity":"743eb1e6-dfa4-4bb2-8677-12ada1c8b290","added_by":"auto","created_at":"2026-04-22 02:36:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":60364,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9193899/v1/635eb984507713f1840dc2db.png"},{"id":107487600,"identity":"e9dc6812-8620-44f1-bcaa-df75b2ed8999","added_by":"auto","created_at":"2026-04-22 02:42:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":465253,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9193899/v1/d702fc8e-14ac-4ecf-9702-4352c5d99d56.pdf"},{"id":107294785,"identity":"194baa48-0723-4d94-9bd7-769df3de57e3","added_by":"auto","created_at":"2026-04-20 06:26:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35068,"visible":true,"origin":"","legend":"","description":"","filename":"CASPchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-9193899/v1/9cb748d85811c4b96ceed5a7.docx"},{"id":107294783,"identity":"b1749200-16f4-4780-8b84-0215d1cc4fc4","added_by":"auto","created_at":"2026-04-20 06:26:54","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":31113,"visible":true,"origin":"","legend":"","description":"","filename":"AMSTARchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-9193899/v1/ec3e4116769b6aed846644e7.docx"},{"id":107294813,"identity":"937a562c-a47b-4276-91c5-be2ef51466c4","added_by":"auto","created_at":"2026-04-20 06:27:00","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":26538,"visible":true,"origin":"","legend":"","description":"","filename":"PRIORchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-9193899/v1/40f0e3c6fa5a7b892f5f8405.docx"},{"id":107294805,"identity":"0971eba3-a601-4716-bf1e-fb5c6f30c261","added_by":"auto","created_at":"2026-04-20 06:27:00","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":177666,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFiles.docx","url":"https://assets-eu.researchsquare.com/files/rs-9193899/v1/d90fdf71b61077797693f91b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implementation and translation science in the mental health practice and service delivery context: a review of existing reviews","fulltext":[{"header":"Contributions to the literature","content":"\u003cul\u003e\n \u003cli\u003eIdentification of common strategies for and challenges to the implementation of evidence-informed interventions and models of care in mental health services\u003c/li\u003e\n \u003cli\u003eUtilisation of implementation frameworks is important to inform implementation design and delivery and approaches to scaling\u003c/li\u003e\n \u003cli\u003eWhen applying the CFIR to understand reviews it confirms the importance of attending to both the broader or external context and the internal operation of organisations when considering implementation of evidence-informed services\u003c/li\u003e\n \u003cli\u003eDemonstrating the value of incorporating lived experience perspectives\u003c/li\u003e\n \u003cli\u003eThe CFIR domains of \u003cem\u003einner setting\u003c/em\u003e and \u003cem\u003eindividual\u003c/em\u003e were reported as having the most impact on innovation implementation in mental health services from 12 review papers, indicating these domains need close attention from mental health change implementers.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eDespite efforts to evaluate new and improved models of care and interventions for people experiencing mental ill-health, (1, 2) a bi-directional disconnection exists between service provision and research. Evidence generated through research is not always implemented into practice, and the realities of delivering or using mental health services are not routinely considered in shaping or translating research (3). Research describing existing or innovative approaches to care that demonstrate positive recovery outcomes for people experiencing mental ill-health or their family, carers, or kin reach service delivery inconsistently and are rarely embedded for the long term. Continuity remains precarious due to factors like insecure funding, shifting service and government priorities, and staff knowledge and acceptance of the innovation to be adopted. Conversely, localised implementation of some practice innovations may outpace existing evidence, making it difficult for services to embed these innovations consistently. Furthermore, involvement of lived experience in generating and critiquing evidence, as well as its implementation into practice, has been limited (4) and where it has occurred few studies report this in depth. There is a need for more effective implementation pathways that recognise a) service provision contexts, b) strong and promising research evidence, and c) lived and living experience perspectives, to enable contemporary, evidence-informed service provision that facilitates meaningful recovery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImplementation science examines the methods and strategies that promote the adoption, integration, and sustainability of evidence into practice (5). A significant lag in translating research evidence into routine practice settings has been recognised (6) with a range of factors hindering the pathways from evidence to practice. Moving from more controlled research contexts and participant groups to the varied contexts of service delivery may require further translation or adaptation of interventions or models of care. Creating space to innovate in busy service environments involves discontinuing low-value or outdated practices and this depends on reducing barriers and fostering change.\u003c/p\u003e\n\u003cp\u003eWhile advances in implementation science highlight the complexity of factors involved in successful implementation, dominant methods of evidence generation often overlook or insufficiently consider relevant barriers and facilitators. They may also minimise the importance of key stakeholders, such as the end users of services. This reveals gaps in researchers' understanding and ability to integrate implementation theory and practice into their work (7). \u0026nbsp;Implementation science offers guidance to researchers, policymakers, service leaders, and other change agents to better align research evidence with service delivery. Effective service improvement and reform that leads to improved recovery outcomes requires a stronger connection between research and practice, along with a focused approach to implementation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome authors of this group are co-leads of the ALIVE National Centre for Mental Health Research Translation’s Implementation and Translation Network (ITN). This group supports implementation and translation research that enables earlier identification of needs across the life course and leads to embedding of preventive interventions to reduce future mental ill-health in various settings. As a group, we bring diverse knowledge and perspectives to research translation and implementation. Co-leads include people with lived experience of mental ill-health, emotional distress and service use, as well as intervention researchers, implementation scientists, epidemiologists, and service providers including general practitioners and mental health providers. This purposeful grouping of multiple perspectives shapes our collective research focus and requires us all to challenge our perspectives on applications of implementation science. Some members hold multiple roles within the National Centre and its activities, while others are external to the Centre. Our inclusion of mental health lived experience perspectives helps address the previous omission of experts by experience in implementation and translation research (8).\u003c/p\u003e\n\u003cp\u003eWe reviewed mental health service literature to see how implementation factors are integrated into research and practice, and how these are reported. Many papers focused on different contexts, making a coherent review difficult. Limited reporting hindered a comprehensive summary. However, we found reviews on implementing innovations in mental health services, covering diverse settings and practices. These reviews allowed us to synthesise concepts, lessons, and identify gaps in implementation knowledge globally. This paper summarises these reviews, showing how implementation and translation are applied in mental health research.\u003c/p\u003e\n\u003cp\u003eThe field of implementation science encompasses theories, models, and frameworks designed to articulate the various types and layers of influence as innovations are implemented into what the field calls 'real-world’ contexts. Examples of these frameworks include Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (RE-AIM) (9), the Consolidated Framework for Implementation Research (CFIR) (10), and the Promoting Action on Research Implementation in Health Services (PARIHS) Framework (11). To organise and synthesise the findings from this review of reviews, we utilise the updated CFIR 2.0 (5) to structure our understanding of barriers and enablers to innovation implementation in high-income countries. While focusing on high-income countries may overlook some contextual factors, we believe that differences in socio-economic, cultural, political, and healthcare settings would be difficult to translate from low- and middle-income countries. The comprehensive structure of CFIR 2.0, its genesis through a metatheoretical analysis of existing frameworks, and feedback from its application in practice and research influenced our choice (5, 12).\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe questions guiding the current review were:\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eHow are the concepts from implementation and translation science being applied in the reporting of mental health service research and reviews of research evidence?\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWhat are the enablers and barriers to implementation of innovative practice that are identified in reviews of mental health service research as articulated through the lens of CFIR 2.0?\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHow has Lived Experience been incorporated into reviews of implementation and translation of research in mental health services?\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Methods","content":"\u003ch3\u003eDesign\u003c/h3\u003e\n\u003cp\u003eThis review of reviews employed a systematic approach to identify and map the evidence base and implementation challenges in the literature, thereby highlighting gaps. It was conducted to synthesise systematic reviews published over the past 15 years. Guided by Fusar-Poli \u0026amp; Radua (13), and Gates et al. (14) and our exploratory research questions, our review adopted a charting and theming approach using the CFIR 2.0. The comprehensive structure of CFIR facilitates the synthesis of diverse information in a consistent and efficient way supporting dissemination of key insights to stakeholders (15).\u003c/p\u003e\n\u003ch3\u003eSearch strategy and inclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eOur search was conducted in September 2025 using ProQuest Central, Medline, PsychInfo, and Cochrane. A research librarian from La Trobe University was consulted to help select the databases and appropriate search terms. We focused on peer-reviewed papers published between January 2010 and August 2025. Our search terms (keywords and MeSH terms) reflected three central concepts: \u0026ldquo;implementation science,\u0026rdquo; \u0026ldquo;mental health,\u0026rdquo; and \u0026ldquo;mental health services\u0026rdquo; (full search string available in additional file 1). These terms covered concepts of implementation science, knowledge translation, and improvement science, as well as the various settings where mental health care is provided, including community, inpatient, outpatient, and educational environments. The search was limited to full-text publications in English.\u003c/p\u003e\n\u003cp\u003eTable 1 presents the inclusion and exclusion criteria used to select papers at each stage of the review.\u003c/p\u003e\n\u003cp\u003eTable 1. Inclusion and exclusion criteria\u003c/p\u003e\n\u003ch3\u003eStudy selection and data extraction\u003c/h3\u003e\n\u003cp\u003eStudy selection followed agreed inclusion and exclusion criteria (Table 1) and managed using the online software Covidence. Four reviewers participated in the screening process. After removing duplicates (411), each paper was screened by two reviewers at three stages: title (JF, DJ), abstract (JF, DJ, EC), and full text (JF, DJ, DGS). A study advanced to the next stage only if it received two \u0026apos;yes\u0026apos; votes during both abstract and full-text screening. The project lead (LB) was consulted to resolve any conflicting votes. Using the research questions, a data extraction table and guidance notes were developed to extract relevant data from the reviews. This included:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; Article identifiers including the topic, age, and setting of the review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; The reported use of implementation and translation science models, theories, and frameworks.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; The specific barriers and enablers related to implementation of the specific model or guideline that was the subject of the review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; Engagement of people with lived experience in any aspect of the review and evidence of involvement of lived experience expertise in conducting the research activity.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eQuality Appraisal\u003c/h3\u003e\n\u003cp\u003eWe chose to use the AMSTAR and the CASP to rate the quality of the papers as neither was completely fit for purpose. Initial ratings on both instruments were conducted by JD and reviewed by JF and came to consensus. The papers rated poorly on the AMSTAR because it is more suited systematic reviews with meta-analyses. The CASP more reliably assessed the quality of the papers even though its primary focus is not review papers. The CASP indicated that the quality of papers improved in more recent years, see supplementary material. As this was a scoping review, we included all papers as they contained relevant information pertaining to the research questions.\u003c/p\u003e\n\u003ch3\u003eSynthesis of Findings\u003c/h3\u003e\n\u003cp\u003eThe CFIR 2.0 provides a framework for organising and synthesising the findings of this review. The CFIR is a meta-theoretical framework comprising five domains (one of which has two subdomains), encompassing 48 constructs and 19 subconstructs, as outlined in Table 2 (5). The CFIR has been utilised in numerous studies of complex mental health services (Gilmer et al., 2013; Fletcher et al., 2021; Brook et al., 2018). A key benefit of the CFIR is that it helps us understand the barriers and enablers of implementing an innovation, as well as providing insight into why and how various processes work (5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[TABLE 2 ABOUT HERE]\u003c/p\u003e\n\u003cp\u003eData were extracted from each review paper using the CFIR domains and constructs. Extracted data were labelled either as a barrier, enabler, or a combination of both. Data extraction was completed by JF and checked by JD. These results are presented as a summary table and narrative synthesis.\u003c/p\u003e\n\u003ch2\u003eFindings\u0026nbsp;\u003c/h2\u003e\n\u003ch3\u003eLiterature Search\u003c/h3\u003e\n\u003cp\u003eTweleve reviews met the inclusion criteria. The Prisma diagram in Figure 1 shows the progress of screening the papers and reasons for exclusion.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1: PRISMA diagram\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll reviews included were described by the authors as systematic reviews (see Table 3). The number of papers reviewed in each study ranged from 12 to 77. Their populations varied, with some not specified and others focused on age groups such as children and youth. The reviews included in this review of reviews concentrated on one or more of the following settings: inpatient, outpatient, community, non-government organisations, education, and primary care. The topics of the reviews were diverse, but all had an implementation focus for mental health.\u003c/p\u003e\n\u003cp\u003e[Table 3 about here]\u003c/p\u003e\n\u003ch3\u003eApplication of implementation and translation science to mental health research and practice.\u003c/h3\u003e\n\u003cp\u003eTen of the reviews reported using at least one theory or framework to guide their analysis, with three reporting the use of two or three theories or frameworks (Table 4). The CFIR was utilised by six of the reviews, while the PARIHS framework was employed by three reviews. Other frameworks or theories included the National Implementation Research Network (NIRN), the Knowledge to Action Process (KT Framework), the Proctor Model, the Exploration, Planning, Implementation, and Sustainment (EPIS) Framework, and the RE-AIM Framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[Table 4 about here]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEnablers and barriers of implementation identified in the literature\u003c/p\u003e\n\u003cp\u003eAll but one review identified enablers of implementation, including staff training, processes, leadership involvement, staff relationships, and innovation flexibility. Nine review papers listed barriers to implementation, such as lack of local adaptation, staff attitudes, perceived incompatibility of the intervention, and inappropriate organisational structures (see Table 4). A detailed synthesis of the barriers and enablers is presented in Table 5, framed using CFIR constructs.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[Table 5 about here]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings from each review paper that indicated influence on the implementation of innovations were mapped to CFIR domains and related constructs. The influence was coded as \u0026lsquo;barrier,\u0026rsquo; \u0026lsquo;enabler,\u0026rsquo; \u0026lsquo;impact not determined\u0026rsquo; (findings reported without establishing the impact on implementation), \u0026lsquo;both enabler and barrier,\u0026rsquo; \u0026lsquo;impact not determined and barrier,\u0026rsquo; or \u0026lsquo;impact not determined and enabler\u0026rsquo; see Table 5 (16). Four review papers reported findings related to each of the five CFIR domains (16-19). The inner setting domain was the only one included in all reviews. The number of constructs reported across reviews varied considerably.\u003c/p\u003e\n\u003cp\u003eThe following synthesis details which CFIR domains and constructs appear in reviews focused on the implementation of innovations in mental health services and their impacts on implementation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInnovation Domain\u003c/p\u003e\n\u003cp\u003eSix reviews reported findings in the Innovation Domain, with each review addressing one to five of the eight constructs in this domain. When included, they enabled implementation. The \u003cem\u003eInnovation Source\u003c/em\u003e was highlighted in one review, which found that when people with lived experience promoted the use of a specific recovery-oriented model, this enabled implementation. Piat et al. (20) also reported that recovery-oriented innovation by design included relationship-building among clinical staff, peer and family workers, and those receiving services. Innovations were seen to have a \u003cem\u003eRelative Advantage\u003c/em\u003e over standard care when there was a focus on staff-patient relationship \u0026nbsp;(18, 20), when there were perceived benefits to patients relating to experience of care, cost effectiveness and better symptom management \u0026nbsp;(19). \u0026nbsp;In contrast, Appleton et al. (2021) reviewed tele-mental health and reported mixed views regarding the Relative Advantage of implementing it. For those in remote locations, accessing care became more straightforward and less costly, but in contrast, clinicians felt that care was compromised due to a lack of non-verbal cues to support reliable assessment of mental health status. \u003cem\u003eInnovation Adaptability\u003c/em\u003e was reported across seven reviews, and the type of adaptation varied according to the innovation, such as the delivery mode (individual or group, in-person or remote). In the Piat et al. (20) review on recovery, flexibility related to the personnel delivering interventions and adapting the intervention to local context, for example, forensic units \u0026nbsp;(18) and individual need (17). In contrast, innovations that were highly manualised and lacked flexibility faced barriers to implementation ((16, 17, 19). Piat et al. (20) also identified that a barrier to implementing recovery-oriented practice was the relational complexity required of staff who were not yet comfortable with the recovery model \u003cem\u003e(Innovation Complexity\u003c/em\u003e). In contrast, \u003cem\u003eInnovation Design\u003c/em\u003e, such as including people with lived experience in the design of recovery-oriented innovations, was viewed by many as an advantage and enabler. (19), also highlight that the \u003cem\u003eInnovation Cost\u003c/em\u003e of team-based functions and infrastructure for the collaborative care model was a barrier in a service system that only accepted individual clinician visits in the payment structure.\u003c/p\u003e\n\u003cp\u003eOuter Setting Domain\u003c/p\u003e\n\u003cp\u003eNine reviews identified findings within the Outer Setting Domain, which included one to four of this domain\u0026rsquo;s 10 constructs and subconstructs per review. The few constructs highlighted were mainly found to facilitate implementation. The Outer Setting Domain is rarely considered in research and evaluation of innovations. However, this domain was in focus when innovations were delivered across systems or countries, such as tele-mental health services during the COVID-19 lockdowns, Veterans Health Administration policy shifts in the USA, or legislation to implement the IPS model. In the Covid-19 case, a \u003cem\u003eCritical Incident\u003c/em\u003e acted as the catalyst for change, with \u003cem\u003eLocal Conditions\u003c/em\u003e in the USA, such as health insurance funding, enabling access to telehealth services for some while acting as a barrier for those without adequate health coverage. In some countries, the impact of network capacity was actively considered, leading to the development of guidelines to assist clinicians in using telehealth, supported by various professional bodies. The review by Rosen et al. highlighted \u003cem\u003eLocal Attitudes\u003c/em\u003e, such as strong political and public interest, as an Outer Setting domain supporting the shift towards more suitable therapy options for Veterans. Veterans\u0026apos; Health Administration (VHA) \u003cem\u003ePolicies\u003c/em\u003e mandating specific evidence-based therapies across all VHA clinics and extending Partnerships and Connections through external training consultants also acted as enablers. Table 6 illustrates the variety of settings and the distinct ways the outer setting influenced implementation.\u003c/p\u003e\n\u003cp\u003eInner Setting Domain\u003c/p\u003e\n\u003cp\u003eAll reviews reported findings classified within the Inner Setting Domain, which covered between one and nine of 21 constructs and subconstructs per review. Constructs within this domain were both barriers and enablers to implementation success. Various \u003cem\u003eStructural Characteristics\u003c/em\u003e influenced implementation; for example, a change in \u003cem\u003ePhysical Infrastructure\u003c/em\u003e was reported as an enabler in two reviews (21, 25). However, outcomes regarding the impact of \u003cem\u003eWork Infrastructure\u003c/em\u003e varied more widely. Being understaffed or unable to attractor retain suitable staff, or lack of protected time, was often a barrier to successful implementation ((17-19). Conversely, strategic changes to work practices that supported new models of care, along with staff training, enabled successful implementation (26).\u003c/p\u003e\n\u003cp\u003eStrong and positive Relational Connections enabled implementation by providing team members with important emotional support, respect, and mutual esteem (16, 20). Paradoxically, strong team cohesion could also be a barrier to implementation when an innovation was not favoured by the team (16). In workplaces where new roles were being established, challenging relationships between clinicians and peer support workers acted as a barrier to implementation (20). Linked to challenges in Relational Connections, a dominant Culture that prioritised the traditional biomedical model was a barrier to implementation of recovery-oriented practice (20). Furthermore, the extent to which the organisation\u0026apos;s Culture was perceived as Recipient-Centred posed a barrier to implementation. For example, in the Lorien et al. review, staff attitudes regarding the value of a recovery approach for service users influenced their willingness to implement recovery-oriented practice in inpatient settings (26). Harkko et al \u0026nbsp;reported that the organisation\u0026apos;s Culture could support implementation when staff attitudes and beliefs aligned with the IPS model and were a barrier when staff reported that IPS was at odds with the organisation\u0026apos;s principles of care (23). Piat et al. also reported that a Culture of Learning Centredness that emphasised the biomedical approach hindered the shift to a recovery-oriented approach (20). Conversely, the use of case and practice-level data for teams and individual clinicians highlighted that a Culture of Learning Centredness on this data was an enabler of implementation (24, 25).\u003c/p\u003e\n\u003cp\u003eIn organisations where the innovation was given Relative Priority, implementation was enabled. Indications of priority included policy changes, communication of support from executives and leaders, amending organisational policies, procedures, record keeping, and staffing. These measures often led to Mission Alignment, which supported implementation) (16, 24, 25). Additionally, some innovations were seen to align with existing organisational priorities, for example, person-centred care (18). In contrast, where incompatible practices continued to be prioritised, the Relative Priority of older practices created a barrier to implementing new innovations. A failure to prioritise recovery compromised Mission Alignment (17, 23, 26). For example, work practices, including the allocation of staff time to talk with consumers, were not adjusted to support implementation (26). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccess to Knowledge and Information, specifically training, was the construct with the most data collected from the included reviews. Training that is specific and interactive, involving all relevant professions, using a variety of practical strategies to practise new skills, ask questions, and receive feedback, enabled implementation. However, in some reviews, despite the availability of appropriate training, barriers to implementation were identified, such as insufficient numbers of staff being trained or trouble retaining trained staff (18). Lorien et al. noted that increased knowledge does not always lead to practice change, and Piat et al. (20) reported incomplete knowledge despite training. Access for staff to Available Resources, such as centralised training at no cost to the organisation and external support, were both enablers of implementation (for example, Harkko et al.) (23). Similarly, internal infrastructure that provided staff with the time and resources for training supported implementation.\u003c/p\u003e\n\u003cp\u003eIndividuals Domain (Roles subdomain \u0026amp; Characteristics subdomain)\u003c/p\u003e\n\u003cp\u003eTen reviews reported findings classified into the Individuals Domain, which covered between one and four of this domain\u0026rsquo;s thirteen constructs and subconstructs per review. Constructs in the \u003cem\u003eIndividuals domain\u003c/em\u003e were more frequently reported as barriers to implementation. In some cases, \u003cem\u003eInnovation Recipients\u0026nbsp;\u003c/em\u003eposed a barrier to implementation when they did not believe the proposed innovation would be effective (16). In the reviewed papers, \u003cem\u003eHigh-level Leaders\u003c/em\u003e played an important role in innovation implementation. Their positive support was an enabler (24, 25), and their lack of support was a barrier (26). Bryson et al., 2017 also mentioned \u003cem\u003eInnovation Deliverers\u003c/em\u003e and the positive impact their support for trauma-informed care had on its implementation. In contrast, Bj\u0026ouml;rkdahl et al. reported that ward-level managers were not supportive of Safewards if they had not been involved in the decision and planning (18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe perception that an innovation will meet the \u003cem\u003eNeeds\u003c/em\u003e of consumers was reported to impact the degree to which \u003cem\u003eHigh-Level Leaders\u003c/em\u003e supported the innovation, and the degree to which \u003cem\u003eInnovation Deliverers\u003c/em\u003e would utilise an innovation in place of current practice (16, 20, 21). However, \u003cem\u003eInnovation Deliverers\u003c/em\u003e were not supportive of implementation if they did not believe the target group had the required capability to utilise IPS (23). Furthermore, successful implementation of the innovation was impacted by the \u003cem\u003eCapability\u003c/em\u003e of \u003cem\u003eInnovation Deliverers\u003c/em\u003e (20, 21). In contrast, psychiatrists who did not receive additional training regarding consultation to primary care felt they lacked the capability to be part of the collaborative care model (19). Finally, one review noted that \u003cem\u003eInnovation Deliverers\u003c/em\u003e were not given \u003cem\u003eOpportunity\u003c/em\u003e in terms of time and resources, and this was a barrier to implementation (25).\u003c/p\u003e\n\u003cp\u003eImplementation Process Domain\u003c/p\u003e\n\u003cp\u003eNine of the twelve reviews identified findings related to the Implementation Process Domain, which covered between one and three of this Domain\u0026rsquo;s fifteen constructs and subconstructs per review. Evidence that \u003cem\u003ePlanning\u003c/em\u003e enabled implementation included documented guidance (16), the establishment of new workflows (21), and the pre-determination of mitigation strategies for potential implementation challenges (20). Conversely, a lack of \u003cem\u003ePlanning\u003c/em\u003e, such as absent or inadequate protocols, guidelines, clear role definitions, and training, created barriers (20). \u003cem\u003eTailoring Strategies\u003c/em\u003e to support implementation, such as Communities of Practice (27) and training methods aligned to the innovation like shadowing and clinical discussions (21), were reported as enablers. \u003cem\u003eEngaging\u003c/em\u003e of a range of stakeholders early in the process was an enabler (20). Early \u003cem\u003eEngagement\u003c/em\u003e of \u003cem\u003eInnovation Deliverers\u003c/em\u003e acted as an enabler, but its absence served as a barrier (20). The same pattern was observed when engaging \u003cem\u003eInnovation Recipients\u003c/em\u003e (21, 25, 26), for example, staff were reminded of the importance of Safewards due to active patient engagement (18). \u003cem\u003eReflecting and Evaluating\u003c/em\u003e about the\u003cem\u003e\u0026nbsp;Implementation\u0026nbsp;\u003c/em\u003eand \u003cem\u003eInnovation\u003c/em\u003e allowed staff to review data, which motivated continued implementation (25). Conversely, when an impact was not observed or communicated to staff, it became a barrier.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eOther models in use in the literature\u003c/h3\u003e\n\u003cp\u003eIn the update of the CFIR, authors highlighted the lack of specific focus on outcomes and advocated the use of the Proctor Taxonomy to deepen understanding regarding implementation outcomes (5). However, only one paper in the review applied the Proctor taxonomy and the CFIR to measure implementation outcomes and described the degree of implementation success according to the categories outlined by the Proctor taxonomy (21). The Proctor taxonomy is useful because it provides a common language that outlines crucial aspects of evaluation, ensuring all stakeholders understand what matters. This model enhances and provides depth to the \u003cem\u003eReflecting and Evaluating\u003c/em\u003e domains of the CFIR, emphasising the importance of clearly defining evaluation criteria to understand the effectiveness of an intervention\u003c/p\u003e\n\u003cp\u003eUsing the Proctor taxonomy, Appleton et al. (21) concluded that the studies showed that greater emphasis was placed on the outcomes of \u003cem\u003eAcceptability and Adoption\u003c/em\u003e, with high levels of acceptance and uptake among both service users and providers being valued. Feasibility was also important, highlighting the practicality of implementing telemental health\u003cem\u003e. Cost and Penetration\u003c/em\u003e were less emphasized but still relevant in assessing the overall impact and reach of the programs. No studies explored\u003cem\u003e\u0026nbsp;Fidelity\u003c/em\u003e in the context of implementation outcomes.\u003c/p\u003e\n\u003ch3\u003eLived Experience inclusion and involvement as found in the literature\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eSix reviews mentioned the involvement of people with lived experience (20, 21, 24-26).The two reviews regarding recovery-oriented practice (20, 26), the review of implementing trauma-informed care (25) and the review of Safewards (18), concerned models of care that are designed specifically to value and include people with lived experience as experts. Table 7 presents a summary of how the reviewed papers described lived experience involvement and its impact.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBryon (25) highlighted the positive impact that involving lived experience had on successful implementation; however, they added that most papers reporting implementation of trauma-informed care did not involve people with lived experience and their families.\u003c/p\u003e\n\u003cp\u003eThe reviews of Lorien et al. (26) and Piat et al. (20) both state that people with lived experience were involved in various ways including storytelling for clinical staff training and being employed as peer workers. However, there was an absence of people with lived experience being included in a genuine co-design capacity (21, 24).\u003c/p\u003e\n\u003cp\u003eTwo other papers only addressed the need for input from lived experience after the review was finished. In their review of knowledge translation for mental health practitioners, Goldner et al.(24) conclude that, in addition to traditional learning methods, practitioners could also learn from people with lived experience and their family members. In the review by Appleton et al.(21) there is a lived experience perspective commentary that highlights the fact that the 77 papers reviewed did not incorporate participatory research approaches, even though it is now widely recognised that this is a crucial element of high-quality research. Furthermore, the commentary states that the review itself was conducted without involving people with lived experience.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e This review of reviews analysed published reviews over the past 15 years of efforts to implement innovations in mental health practice to understand how implementation science concepts are adopted and reported in mental health research. As members of a diverse network of researchers, service providers, and individuals with lived experience, we aimed to identify which implementation strategies promoted innovation and to better understand the barriers and enablers to evidence-based implementation in this field. An additional question explored whether and how lived experience perspectives were involved in generating, translating, and implementing evidence in mental health services.\u003c/p\u003e \u003cp\u003eLived experience involvement in the reviews was limited despite recognition of its importance (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Of the reviews that mentioned lived experience involvement (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), all acknowledged that most of the papers they examined did not involve people with lived experience or their families, and none mentioned involving lived experience experts in conducting or reporting their reviews. A lived experience commentary in the Appleton et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) paper argued that lived experience involvement is integral to ensure that no aspect of the research is missed, misunderstood, or skewed. As a group, we reflected that without meaningful involvement of this critical perspective in all phases of implementation research, gaps will continue to affect the recipients of innovation (as described by the CFIR- Individual domain, role subdomain I). We observed that the numerous domains within CFIR may overshadow or diminish the critical importance of innovation recipients, and that the lived experience lens is needed across many CFIR domains.\u003c/p\u003e \u003cp\u003eWe found little to no reflection on the use of implementation and translation science in the individual research papers reviewed. Each review paper focused on the implementation of a specific practice innovation by examining a group of published studies, but it was the review papers themselves that introduced and used a framework to organise and report findings. Piat et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) highlighted the difficulty of identifying what constitutes an implementation study, especially when there was minimal reference to an implementation framework. In their critical review of e-mental health approaches for depression and anxiety, Ellis and colleagues (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) emphasised the lack of application of implementation science in most studies. They strongly advocated for using frameworks to guide the collection of implementation data and to understand factors influencing real-world implementation. They also supported mixed-methods research as the best approach for gaining a deep understanding of implementation successes and failures. The review papers included in this current synthesis of reviews commonly concluded that implementing practice change and scaling up innovations is complex (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), and the barriers to successful implementation are specific to context and setting (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Recognising that practice change is challenging and multifaceted is valuable because simpler interpretations tend to obscure or overlook the complexity, undermining efforts to adopt or sustain changes.\u003c/p\u003e \u003cp\u003eWe decided to use the revised and increasingly utilised CFIR to structure our analysis but recognise that this framework has both strengths and limitations. Like Ellis (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), we appreciated how CFIR helped us better understand the range of factors involved in implementation, demonstrating the value of structured implementation frameworks. The various factors considered by CFIR, including inner and outer settings, the individuals involved, and the innovation itself, allowed us to adopt a comprehensive approach to many elements we found important from our different perspectives working across diverse regions and communities. However, we remain aware that the theoretical basis of CFIR is not universally accepted within the evolving field of implementation science and that not all perspectives have had opportunity to influence this framework. We agree that curiosity about the still-missing elements within CFIR is necessary.\u003c/p\u003e \u003cp\u003e Our review highlighted the complex interplay between the five CFIR domains in efforts to implement innovations. Our findings suggest that the constructs in the Innovation Domain may be the initial positive drivers of successful implementation, as demonstrated by Piat et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The source, design, perceived relative advantage, and adaptability all contributed to enabling the implementation of recovery-oriented practice. Veldmeijer and colleagues (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), also found lived experience perspectives in the design of innovations is critical. The Outer Setting domain also enabled implementation in various ways, but its impact was highly specific to the innovation and the implementation context. Implementers need to consider social, political, and economic factors beyond the inner implementation context to foster successful innovation and remain alert to the outer setting factors fostering success in one setting and hindering it in another (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe observed significant attention to, and variability within, the Inner Setting Domain, likely because this domain considers the specific culture of the organisation where implementation takes place, raising researcher awareness of local factors affecting the process. Similarly, findings related to the Individuals Domain are often more evident to researchers, who can observe and sometimes measure staff and organisational leaders' attitudes. The findings we could link to the Implementation Process Domain highlight the lack of thorough and careful planning in research implementation. However, our findings show that implementation success improves when strategies are tailored and when engagement of those -involved is prioritised. This aligns with other studies that use implementation frameworks to plan for successful implementation. Authors King et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and Roshan et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) argue that research teams need to take time to identify relevant domains that are likely to influence the adoption, implementation, and maintenance of an intervention. These domains can be used to tailor implementation strategies and to guide regular monitoring of impact, as well as the quick identification of emerging implementation challenges.\u003c/p\u003e \u003cp\u003eThe papers on recovery orientation offer a clear example of the complex, interconnected relationships among the CFIR constructs. Implementing recovery-oriented practices represented a significant shift in thinking and practice for organisations and staff accustomed to, or preferring, a biomedical approach. This explained low engagement in training, limited individual staff motivation, and unadjusted work practices that did not support the innovation. While reports on the challenges of implementing recovery-oriented practice worldwide are common (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), these findings clarify the types of implementation strategies that require attention to improve real-world implementation success.\u003c/p\u003e \u003cp\u003eKnowledge Translation was the only approach commonly discussed across multiple papers in our review; however, Knowledge Translation is only one part of a comprehensive implementation strategy, and relying solely on this strategy may be insufficient to bring about practice change (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). For knowledge translation strategies to work effectively, local context requires consideration, and organisational barriers must be addressed (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Efforts in knowledge translation primarily focused on staff training, despite research rarely measuring or presenting convincing evidence of training\u0026rsquo;s impact on knowledge and skill acquisition (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Intervention fidelity and clinician behaviour change that leads to practice change cannot depend on staff training alone (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Well-designed training based on adult learning principles, which is clearly reported, may improve the quality of training and, in turn, its impact (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this review of systematic reviews, the measurement of implementation success has been inconsistent, often relying on data that is convenient and readily available rather than fit for purpose. The CFIR\u0026rsquo;s lack of emphasis on clearly defined implementation outcomes is a limitation of the framework. The Proctor Model offers a comprehensive way to measure and report implementation outcomes, and Damschroder et al (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) have promoted its use in the update to the CFIR. Appleton et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) successfully employed the Proctor Model to synthesise the outcomes of the studies they reviewed, noting that outcomes related to acceptability, adoption, and feasibility were most frequently reported, but fidelity was not reported at all. Other missing elements concern issues of equity and power. As we have indicated, further incorporating lived experience perspectives is a vital step in addressing this gap.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTo see the promises of reform and improved outcomes for people accessing mental health services, attention needs to be paid to implementing research findings in real-world settings. Our review shows that implementing innovations is complex, and few research efforts acknowledge or report this complexity. Frameworks like CFIR are detailed, but researchers could improve the translation process by engaging with the diverse domains and constructs throughout a project, as these can offer a deeper understanding of potential barriers and enablers. During planning, selective focus on the most relevant domains and constructs for the innovation and specific context is required, but this focus should flex as challenges arise throughout implementation. Remaining open and curious about factors not covered in CFIR is also important, as is choosing frameworks that suit the issue at hand.\u003c/p\u003e \u003cp\u003eThis paper aims to highlight the challenges associated with implementing mental health interventions in real-world contexts. We emphasise that, although lived experience perspectives are considered valuable for implementation, their inclusion is not yet common practice. Additionally, we agree with Chambers and Emmons (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) that raising awareness of this issue should encourage prioritising implementation science in research design, allowing the field to mature and grow.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Not applicable\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u0026nbsp;All data generated are available in the manuscript or in the supplementary material\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u0026nbsp;The authors declare no competing interests\u003c/p\u003e\n\u003cp\u003eFunding:\u0026nbsp;This project was supported by the ALIVE National Research Translation Centre for Mental Health through the National Health and Medical Research Council (NHMRC) Special Initiative in Mental Health (grant number APP2002047)\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eJF: Conceptualization, Methodology, Formal Analysis, Investigation, Data Curation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing, Visualization, Supervision\u003c/p\u003e\n\u003cp\u003ePE: Conceptualization, Methodology, Formal Analysis, Investigation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eDS: Methodology, Formal Analysis, Investigation, Data Curation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eJN: Investigation, Data Curation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eDJ: Conceptualization, Methodology, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eHP: Conceptualization, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eEC: Conceptualization, Methodology\u003c/p\u003e\n\u003cp\u003eVP: Conceptualization, Methodology, Writing \u0026ndash; Review \u0026amp; Editing, Supervision\u003c/p\u003e\n\u003cp\u003eLB: Conceptualization, Methodology, Formal Analysis, Investigation, Data Curation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing, Supervision, Project Administration\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003eAcknowledgements: The authors wish to acknowledge the Implementation \u0026amp; Translation Network \u0026ndash; The Alive National Centre for their expertise and input into this work\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKillaspy H, Harvey C, Brasier C, Brophy L, Ennals P, Fletcher J, et al. Community‐based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence. World psychiatry. 2022;21(1):96-123.\u003c/li\u003e\n \u003cli\u003eHarvey C, Zirnsak T-M, Brasier C, Ennals P, Fletcher J, Hamilton B, et al. Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis. Frontiers in psychiatry. 2023;14:1259944.\u003c/li\u003e\n \u003cli\u003ePalmer VJ, Wheeler AJ, Jazayeri D, Gulliver A, Hegarty K, Moorhouse J, et al. Lost in translation: a narrative review and synthesis of the published international literature on mental health research and translation priorities (2011-2023). J Ment Health. 2024;33(5):674-90.\u003c/li\u003e\n \u003cli\u003eBanfield M, Palmer VJ. Embedding lived experience in mental health research: what we need to pack (and unpack) for the future in mental health research and translation. BMJ open. 2025;15(5):e098557.\u003c/li\u003e\n \u003cli\u003eDamschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implementation science : IS. 2022;17(1):75-16.\u003c/li\u003e\n \u003cli\u003eRobinson T, Bailey C, Morris H, Burns P, Melder A, Croft C, et al. Bridging the research\u0026ndash;practice gap in healthcare: a rapid review of research translation centres in England and Australia. Health research policy and systems. 2020;18(1):1-17.\u003c/li\u003e\n \u003cli\u003eYounas A. Potential Factors Contributing to and Strategies for Reducing Implementation Science-Practice Gap: A Discussion. Global implementation research and applications. 2024;4(3):361-\u003c/li\u003e\n \u003cli\u003eDruss BG, Jones N. Evidence-Based Practicing in Mental Health. JAMA psychiatry (Chicago, Ill). 2025;82(5):433-4.\u003c/li\u003e\n \u003cli\u003eGlasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American journal of public health (1971). 1999;89(9):1322-7.\u003c/li\u003e\n \u003cli\u003eDamschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation science : IS. 2009;4(1):50-.\u003c/li\u003e\n \u003cli\u003eRycroft-Malone J. The PARIHS Framework\u0026mdash;A Framework for Guiding the Implementation of Evidence-based Practice. Journal of nursing care quality. 2004;19(4):297-304.\u003c/li\u003e\n \u003cli\u003eKirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the Consolidated Framework for Implementation Research. Implementation science : IS. 2016;11(1):72.\u003c/li\u003e\n \u003cli\u003eFusar-Poli P, Radua J. Ten simple rules for conducting umbrella reviews. BMJ mental health. 2018;21(3):95-100.\u003c/li\u003e\n \u003cli\u003eGates M, Gates A, Guitard S, Pollock M, Hartling L. Guidance for overviews of reviews continues to accumulate, but important challenges remain: a scoping review. Systematic reviews. 2020;9(1):254-.\u003c/li\u003e\n \u003cli\u003eKirk MA, Kelley C, Yankey N, Birken SA, Abadie B, Damschroder L. A systematic review of the use of the Consolidated Framework for Implementation Research. Implementation science : IS. 2016;11(1):72-.\u003c/li\u003e\n \u003cli\u003eRosen CS, Matthieu MM, Wiltsey Stirman S, Cook JM, Landes S, Bernardy NC, et al. A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration. Administration and policy in mental health and mental health services research. 2016;43(6):957-77.\u003c/li\u003e\n \u003cli\u003eAhmed H, Bendall C, Anwar F, Al‐Janabi M, Wood L. A Systematic Review and Narrative Synthesis Examining the Facilitators and Barriers of Psychological Intervention Delivery in Crisis Resolution Home Treatment Teams. Clinical psychology and psychotherapy. 2024;31(4):e3032-n/a.\u003c/li\u003e\n \u003cli\u003eBj\u0026ouml;rkdahl A, Johansson U, Kjellin L, Pelto‐Piri V. Barriers and enablers to the implementation of Safewards and the alignment to the i‐PARIHS framework \u0026ndash; A qualitative systematic review. International journal of mental health nursing. 2024;33(1):18-36.\u003c/li\u003e\n \u003cli\u003eMauer-Vakil D, Sunderji N, Webb D, Rudoler D, Allin S. Approaches to Integrate Mental Health Services in Primary Care: A Scoping Review of System-Level Barriers and Enablers to Implementation. Canadian Journal of Community Mental Health. 2023;42(3):29-45.\u003c/li\u003e\n \u003cli\u003ePiat M, Wainwright M, Sofouli E, Vachon B, Deslauriers T, Pr\u0026eacute;fontaine C, et al. Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review. Systematic reviews. 2021;10(1):134-.\u003c/li\u003e\n \u003cli\u003eAppleton R, Williams J, Juan NVS, Needle JJ, Schlief M, Jordan H, et al. Implementation, Adoption, and Perceptions of Telemental Health during the COVID-19 Pandemic: Systematic Review. Journal of medical Internet research. 2021;23(12):e31746-e.\u003c/li\u003e\n \u003cli\u003eGirlanda F, Fiedler I, Ay E, Barbui C, Koesters M. Guideline implementation strategies for specialist mental healthcare. Current opinion in psychiatry. 2013;26(4):369-75.\u003c/li\u003e\n \u003cli\u003eHarkko J, Sipil\u0026auml; N, Nordquist H, Lallukka T, Appelqvist-Schmidlechner K, Donnelly M, et al. External context in individual placement and support implementation: a scoping review with abductive thematic analysis. Implementation science : IS. 2023;18(1):61-23.\u003c/li\u003e\n \u003cli\u003eGoldner EM, Jenkins EK, Fischer B. A Narrative Review of Recent Developments in Knowledge Translation and Implications for Mental Health Care Providers. Canadian journal of psychiatry. 2014;59(3):160-9.\u003c/li\u003e\n \u003cli\u003eBryson SA, Gauvin E, Jamieson A, Rathgeber M, Faulkner-Gibson L, Bell S, et al. What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. International journal of mental health systems. 2017;11(1):36-.\u003c/li\u003e\n \u003cli\u003eLorien L, Blunden S, Madsen W. Implementation of recovery‐oriented practice in hospital‐based mental health services: A systematic review. International journal of mental health nursing. 2020;29(6):1035-48.\u003c/li\u003e\n \u003cli\u003eBarwick MA, Schachter HM, Bennett LM, McGowan J, Ly M, Wilson A, et al. Knowledge Translation Efforts in Child and Youth Mental Health: A Systematic Review. Journal of evidence-based social work. 2012;9(4):369-95.\u003c/li\u003e\n \u003cli\u003eSartor C. Mental health and lived experience: The value of lived experience expertise in global mental health. Global mental health. 2023;10:e38-e.\u003c/li\u003e\n \u003cli\u003eSunkel C, Sartor C. Perspectives: involving persons with lived experience of mental health conditions in service delivery, development and leadership. BJPsych Bulletin. 2022;46(3):160-4.\u003c/li\u003e\n \u003cli\u003eEllis LA, Augustsson H, Gr\u0026oslash;dahl AI, Pomare C, Churruca K, Long JC, et al. Implementation of e‐mental health for depression and anxiety: A critical scoping review. Journal of community psychology. 2020;48(3):904-20.\u003c/li\u003e\n \u003cli\u003eVeldmeijer L, Terlouw G, Van Os J, Van Dijk O, Van \u0026apos;t Veer J, Boonstra N. The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review. JMIR mental health. 2023;10:e46590.\u003c/li\u003e\n \u003cli\u003eKing DK, Shoup JA, Raebel MA, Anderson CB, Wagner NM, Ritzwoller DP, et al. Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study. Frontiers in public health. 2020;8:59-.\u003c/li\u003e\n \u003cli\u003eRoshan R, Hamid S, Kumar R, Hamdani U, Naqvi S, Zill e H, et al. Utilizing the CFIR framework for mapping the facilitators and barriers of implementing teachers led school mental health programs \u0026ndash; a scoping review. Social Psychiatry and Psychiatric Epidemiology. 2025;60(3):535-48.\u003c/li\u003e\n \u003cli\u003eChatwiriyaphong R, Moxham L, Bosworth R, Kinghorn G. The experience of healthcare professionals implementing recovery‐oriented practice in mental health inpatient units: A qualitative evidence synthesis. Journal of psychiatric and mental health nursing. 2024;31(3):287-302.\u003c/li\u003e\n \u003cli\u003eMartinelli A. An overview of mental health recovery-oriented practices: potentiality, challenges, prejudices, and misunderstandings. Journal of Psychopathology. 2020;26(2):147.\u003c/li\u003e\n \u003cli\u003eCurtis K, Fry M, Shaban RZ, Considine J. Translating research findings to clinical nursing practice. Journal of clinical nursing. 2017;26(5-6):862-72.\u003c/li\u003e\n \u003cli\u003eJolliffe L, Lannin NA, Larcombe S, Major B, Hoffmann T, Lynch E. Training and education provided to local change champions within implementation trials: a rapid systematic review. Implementation science : IS. 2025;20(1):8-40.\u003c/li\u003e\n \u003cli\u003eChambers DA, Emmons KM. Navigating the field of implementation science towards maturity: challenges and opportunities. Implementation science : IS. 2024;19(1):26-.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Inclusion and exclusion criteria\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eInclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eExclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eMental Health related reviews conducted between 2010 and 2025, anywhere in the world in English\u003c/li\u003e\n \u003cli\u003eReviews that primarily report on implementation (strategies used, enablers, barriers, implementation data, fidelity organisational culture/characteristics) \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReviews that have purposefully collected data to answer implementation questions about implementation of practice innovation in a service context\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReviews that have used data collection to inform implementation and translation questions \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli\u003eReviews of mental health focused studies that report on translation and/or scalability\u003c/li\u003e\n \u003c/ul\u003e\n \u003cul\u003e\n \u003cli\u003eReviews that consider the mental health service setting/context\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eReviews conducted in low- and middle-income countries\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eProtocol papers, editorials, commentaries, and opinion pieces\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePapers not in English\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReviews only including implementation of measures, health record data collection, software\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReviews of reviews without implementation data (for example classic RCTs)\u003c/li\u003e\n \u003cli\u003eReviews involving medication only\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReviews with a population related to intellectual disabilities and developmental disorders\u003c/li\u003e\n \u003cli\u003eReviews primarily related to a medical condition such as HIV, Cancer etc with mental health consequences for family or others\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6. Outer Setting Domain examples of findings\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConstruct\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReview Paper Topic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExample\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA. Critical Incidents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCovid-19 telemental health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eAppleton et al.\u0026nbsp;(21)\u0026nbsp; reported that Covid-19 lockdowns resulted in Treatment as Usual being shifted to remote ways of working\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB. Local Attitudes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eVeterans Mental Health in USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eRosen et al.\u0026nbsp;(16)\u0026nbsp;reported strong political attention to help Veterans and improve the care they receive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003ePsychological Intervention Delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eAhmed et al.\u0026nbsp;(17) highlighted that valuing the social system within CRHTTs and including family therapies supported implementation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC. Local Conditions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCovid-19 telemental health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eAppleton et al.\u0026nbsp;(21)\u0026nbsp;reported that health cover for telemental health varied across the USA, so was both an enabler and barrier, while in Europe it was covered for the first wave of Covid-19. Platform developers worked to increase network capacity and professional bodies posted supporting guidelines on their websites. One challenge was concerns about video tools having a lack of adherence to strict privacy policies that bind mental health professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCollaborative primary mental health care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eMauer-Vakil et al.\u0026nbsp;(19), highlighted that in small communities, the lack of psychiatrists and family physicians meant that integration of collaborative care was not achieved.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD. Partnerships \u0026amp; Connections\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eVeterans Mental Health in USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eImplementation of Cognitive Processing Therapy and Prolonged Exposure Therapy was enabled by trained clinicians being supported over the longer term (one year plus) by training consultants with patient. Support was tailored to the individual clinician and focus on the therapy being implemented\u0026nbsp;(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eGuideline Implementation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eGirlanda et al.\u0026nbsp;(22) mentioned educational outreach visits\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eIndividual placement and support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eHarkko et al.\u0026nbsp;(23)\u0026nbsp;reported that national, state and regional organisations that provide support, training and technical assistance facilitated implementation and sustainment of the IPS model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCollaborative primary mental health care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eMauer-Vakil et al.\u0026nbsp;(19) reported implementation success in part due to participation in a national collaborative network.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eE. Policies \u0026amp; Laws\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eVeterans Mental Health in USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eRosen et al. reported two National Policies and the\u0026nbsp;Veterans Health Administration\u0026nbsp;(VHA) policy that support the implementation of Trauma-Informed therapies, and providing almost ideal policy and organisational leadership conditions for successful implementation (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eKnowledge Translation (KT)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eIn Goldner et al., Knowledge Translation emphasises the value of policy and law in providing the framework for system change and policy to guide practice\u0026nbsp;(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eRecovery-oriented practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003ePiat et al. reported how funders who did not support roles required for an innovation, for example peer worker roles, were a barrier to implementation of recovery-oriented practice\u0026nbsp;(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eIndividual placement and support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eHarkko et al. found competing legislation. Legislation mandating the use of IPS facilitated implementation; however, some social insurance criteria meant that some clients were excluded from IPS\u0026nbsp;(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eSafewards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eBj\u0026ouml;rkdahl et al reported that legislation, government sponsorship and regulatory frameworks supported the implementation of Safewards in a number of countries\u0026nbsp;(18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCollaborative primary mental health care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eMauer-Vakil et al \u0026nbsp;report that in Canada, \u0026nbsp;the existing complexity of billing procedures, licensing and credentialing rules about who can deliver services, and rules about physical and mental health services being billed on the same day, all acted as barriers to the implementation of collaborative care\u0026nbsp;(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF. Financing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eIndividual placement and support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eHarkko et al reported that in the Netherlands and Canada, direct funding schemes from government or health ministries facilitated uptake of IPS. Whilst funding specific to medical diagnosis, or divided funding sources were barriers to the uptake of IPS\u0026nbsp;(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCollaborative primary mental health care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eMauer-Vakil et al. 2025 noted lack of funding for mental health workers in primary care via the same system as general practitioners was a barrier to implementing and sustaining collaborative care\u0026nbsp;(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eG. External Pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eKnowledge Translation (KT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eGoldner et al. discusses the utility of mass media campaigns to educate the public about innovations, but these may also serve to provide motivation to organisations to deliver evidence-based services. They also discuss the value of community mobilisation\u0026nbsp;(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eIndividual placement and support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003eHarkko et al. reported IPS implementation was facilitated when researchers partnered with policy makers and implementing organisations to promote uptake and training\u0026nbsp;(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Reported Lived Experience Involvement\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLived Experience Involvement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eBj\u0026ouml;rkdahl et al. (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cp\u003eLived experience was acknowledged as an important enabler in the implementation of Safewards. The study highlighted how patient involvement, particularly through sharing personal experiences, helped staff better understand the relevance and impact of the Safewards interventions. Inclusion of lived experience was seen as enhancing staff engagement and encouraged staff to be more involved and support recovery focused care. Patient involvement was viewed as an enabler of implementation by strengthening collaboration and helping staff use the interventions more regularly. Positive patient feedback motivated staff, whereas limited patient involvement was identified as a barrier to adoption\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eBryson et al.\u003c/p\u003e\n \u003cp\u003e(25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cp\u003eWhen community inclusion was discussed, staff are supported through training, coaching, supervision, debriefing, and self-care. Patients and families are consulted and included in their own care plans and in staff training to help staff understand patient and family experiences especially when patients spoke directly to staff about their lived experience\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eLorien et al.\u003c/p\u003e\n \u003cp\u003e(26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cp\u003eConsumers shared their lived experience story as a way of training staff in recovery-oriented practice. One study collected concurrent measures of consumer perception of recovery-oriented staff behaviours. One study where consumers shared their personal recovery stories did increase staff hope in recovery. Staff working in hospital-based mental health services see consumers when they are in crisis. Therefore, having consumers share their stories of recovery post-discharge, may be pivotal in changing staff attitudes to be more optimistic about recovery for service users\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ePiat et al.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cp\u003eLived experience across innovations, the inclusion of people with lived experience of mental health challenges was a valued aspect of designing and packaging recovery-oriented innovations.\u0026nbsp;\u003cbr\u003e\u0026nbsp;When the source of the intervention was a person or group of people with lived experience, this was viewed positively. Those with lived experience were perceived to have a relative advantage over other staff when it came to working in a recovery-oriented way\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"implementation-science-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"iscm","sideBox":"Learn more about [Implementation Science Communications](https://implementationsciencecomms.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ISCM/default.aspx","title":"Implementation Science Communications","twitterHandle":"@ImplementSci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Implementation Science, Consolidated Framework for Implementation Research, Mental health research, Mental health service","lastPublishedDoi":"10.21203/rs.3.rs-9193899/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9193899/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e Ensuring findings from research directly influence practice in mental health services has been limited despite policy-based support for reform and innovation. Implementation of evidence-informed interventions and models of care in mental health services is challenging and is delaying potential benefits for people who access services. Even when evidence does inform changes in service delivery, it may not result in anticipated changes or be sustained or scaled as planned. This review aimed to explore how implementation and translation science is being applied to mental health services’ research and practice in high income countries and to identify the enablers and barriers to the implementation of evidence-informed approaches into service delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e In this review of reviews, we searched four databases: ProQuest Central, Medline, PsychInfo, and Cochrane to identify review papers that reported findings related to implementation of innovations in mental health services. The Consolidated Framework for Implementation Research (CFIR), a comprehensive framework for investigating and understanding the factors that influence implementation of innovations, was used to synthesise the data extracted from the reviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eTwelve reviews met the inclusion criteria, with most employing an implementation science framework to report their findings. After applying the CFIR, we found that the Inner Setting Domain and Individuals Domain of the CFIR were reported to have the most impact on implementation of innovations across various mental health settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eFurther prioritisation and application of implementation science is required to address the evidence to practice gap in mental health service delivery, and to deliver improved outcomes and experiences for people who uses mental health services. Service providers attempting to implement innovations require knowledge of factors that effectively drive and sustain change to optimise their implementation efforts.\u003c/p\u003e","manuscriptTitle":"Implementation and translation science in the mental health practice and service delivery context: a review of existing reviews","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-20 06:26:20","doi":"10.21203/rs.3.rs-9193899/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-01T21:27:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T06:32:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"23119349467043660315537689318474221408","date":"2026-04-22T01:13:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33319240082030344016110938964228659085","date":"2026-04-17T03:27:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257751304318041548190332070079863429435","date":"2026-04-16T07:58:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316760225468495183565784901763843007771","date":"2026-04-12T14:45:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-10T07:40:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T15:14:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-23T07:16:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"Implementation Science Communications","date":"2026-03-22T22:21:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"implementation-science-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"iscm","sideBox":"Learn more about [Implementation Science Communications](https://implementationsciencecomms.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ISCM/default.aspx","title":"Implementation Science Communications","twitterHandle":"@ImplementSci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"53e048e6-59cc-4463-8358-9e5d62f23615","owner":[],"postedDate":"April 20th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-01T21:27:02+00:00","index":51,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T06:26:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-20 06:26:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9193899","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9193899","identity":"rs-9193899","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}