Evaluation is a burgeoning field of health care program research. Experimental designs and meta-analyses have traditionally been considered the most suitable means of assessing program effectiveness. Qualitative methods also have been widely adopted. Mixed-methods designs have now emerged as a promising alternative. This paper highlights the key features of contemporary mental health program implementation and evaluation. Realistic Evaluation is identified as a relatively new methodology that is more concerned with a deeper process-oriented inquiry and appreciates that any program must be understood within the given context. Two projects applying Realistic Evaluation are cited to illustrate the value of this methodology to mental health program research.