Structuring Mental Health Care around Evidence and Recovery

Lucene Wisniewski is the Founder and Chief Clinical Officer of the Center for Evidence-Based Treatment in Ohio. With nearly three decades of experience in clinical psychology, her career reflects a non-linear path shaped by both research and clinical practice. She entered graduate school with a research focus and little intention of seeing patients, but over time, exposure to patient care and wide variation in therapy quality shifted her direction. She believes effective mental health care requires more than good intentions and must be grounded in evidence-based, disorder-specific treatment. Today, her work focuses on applying research-supported models in clinical practice to ensure care is appropriate, effective and scientifically grounded.

Through this article, Wisniewski emphasizes that high-quality mental health care requires matching the proper treatment to the right problem, continuously measuring outcomes and adjusting care when needed. She also highlights that patient-centered care must be sustainable for clinicians and organizations alike if it is to work overtime.

What Good Care Actually Requires

There is a version of mental health treatment that looks fine on the surface. Someone makes an appointment, shows up each week and leaves an hour later. Sessions happen, notes get written and yet nothing meaningfully changes. I have spent enough time in this field to know that activity and progress are not the same thing and that the difference between the two is where most of the real work lies.

Matching the Treatment to the Problem

The foundation of how I think about care starts with a simple premise. Different problems require different solutions. Depression, anxiety and eating disorders each have distinct bodies of research behind them and treating any of these well means understanding what the science actually says about that specific condition. General support has its place, but when someone presents with a diagnosable disorder, vague helpfulness is not enough. The treatment has to match the problem and the person delivering it has to be genuinely trained in it.

This is why I spend serious time on matching. In many settings, scheduling is driven by availability, which tells you almost nothing about whether a therapist can actually help with what someone is facing. Getting that match right is not an administrative detail. It is one of the most direct levers we have on outcomes and I treat it accordingly.

From there, the goal is to move beyond a session-bysession mentality and think more deliberately about what recovery actually looks like. Evidence-based treatment means the content stays consistent because it is grounded in research. What shifts is the delivery. Someone who is neurodivergent or who learns differently needs the material taught in a way that works for them, not a watered-down version of the treatment. The discipline is in staying faithful to what the science supports while remaining genuinely responsive to the person in front of you. That balance is harder than it sounds and it is what I think about more than almost anything else.

Why Access Is a Clinical Problem, Not Just a Logistical One

What I have also learned, sometimes painfully, is that access problems are not just logistical. They are clinical. I was recently speaking with a mother trying to help her adult son get treatment for substance use. We found a program with real expertise in what he needed. But when she called, the earliest opening was weeks out. By the time that date arrived, he had lost interest in getting help. The care existed. The moment had passed.

That window matters in a way that the system rarely accounts for. Deciding to ask for help often takes enormous effort and what happens next can quietly determine whether someone follows through or quietly retreats. When responses are slow or intake drags on, motivation that was already fragile tends to disappear before treatment ever begins. I think about that mother often. There was no failure of expertise involved. It was a timing issue and timing in this field is frequently underestimated.

Measuring Whether Care Is Actually Working

Assuming someone does make it through the door, the next question is whether the care is actually working. This sounds obvious, but without consistent measurement, it is easy to mistake presence for progress. We have used structured assessments from the beginning, both at intake and throughout treatment, because patterns matter and you need data to see them. We are now working to bring that information more directly into our electronic systems so that signals do not get buried and we can respond before things drift.

This is especially important in areas like eating disorder treatment, where research gives us not just evidence that improvement should happen but a reasonable sense of when. When expected change does not appear on that timeline, it is not an indication of insufficient effort or willpower on the patient’s part. It is a clinical signal. It means stepping back, returning to the literature and reconsidering the approach rather than continuing out of inertia. Care that can move with that kind of awareness is far more likely to reach people while it still can.

Where Technology Can Genuinely Help

I do not think technology will change what is most essential about clinical work. The relationship, the trust built over time, the quality of attention a therapist brings into the room, none of that gets replaced. But I do see real potential in the places where technology could relieve pressure that has always made the work harder than it needs to be.

Documentation is one of them. If AI can meaningfully reduce the hours clinicians spend writing notes after sessions, that has a compounding effect. Clinicians stay more present, carry less administrative weight and have more capacity for the actual work. I am also paying attention to how technology might support consistency in treatment delivery, specifically the possibility of reviewing sessions and receiving real-time feedback on whether a treatment is being delivered as intended. That is not surveillance. It is the kind of support that serious practitioners should want.

Beyond the session itself, there is a growing conversation about what happens between appointments, not as a replacement for therapy, but as a way to help people practice skills, complete structured work and stay connected to what they are building outside the room. Change does not happen only in the hour we spend together. It happens in real life, in the accumulated practice of applying what has been learned and technology that supports that between-session work reflects something true about how recovery actually unfolds.

Holding Everything Together

None of this is sustainable without also attending to the people delivering care. Therapists carrying only high-acuity or actively suicidal patients over time will not last and their leaving harms everyone who would have come after. Caseloads need to be balanced and organizations need to be financially viable, not as a concession to business concerns but because a practice that cannot sustain itself cannot serve anyone. I treat patient outcomes, clinical rigor, therapist wellbeing and financial feasibility as a single problem rather than four competing ones. There is no formula for that. There is only the ongoing discipline of keeping all of it in view at once, which is, as far as I can tell, what leading care well actually asks of you.