The slow diffusion of empirically supported treatments and the rapid diffusion of treatments lacking empirical support play a significant role in the quality gap in the care of people with severe mental illnesses. Further, the rapid diffusion of treatments of low cost-effectiveness limits the system's ability to provide the full gamut of high-value treatments available to treat this vulnerable population. Using the case of schizophrenia as an illustrative case study, we review the context in which these paradoxical patterns of diffusion have occurred and propose policy solutions