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Adults and children treated in the public mental health sector face a number of challenges including poverty, social isolation, and obstacles in accessing general health and mental health services. These challenges lead to adverse public health outcomes including reduced quality of life and shortened lifespans. Improving these outcomes requires understanding potential facilitators and barriers to the uptake of best practices including state and federal policies, the structure and functioning of public sector delivery systems (including its workforce), and financing. Implementation strategies that account for systems-level challenges are needed to ensure the uptake of evidence-based practices in public mental health settings.