Throughout its two and a half centuries in existence, US mental health policy has repeatedly failed people living with schizophrenia. The failures are cyclical—the inhumane conditions uncovered in the first 75 years of existence were addressed with the construction of state asylums to deliver moral treatment. One hundred years later, the asylums were themselves revealed to be inhumane. Deinstitutionalization, the response to the failure of asylums starting in the 1960s, now drives outcomes such as homelessness, incarceration, and early death for people living with psychotic illnesses. In all cases, well-intentioned policy reform has failed at the level of implementation, largely due to a lack of accountability. The result has been a consistent failure to adequately treat people living with schizophrenia, which is now understood to be a highly treatable condition. As the country passes into a quarter millennium in existence, reform is once again underway. Unlike other points in history, there is good news. Other countries, such as Italy, have successfully leveraged reform to achieve greatly improved outcomes. Understanding US history and the successful implementation of policy change in other countries is imperative and teaches us that accountability in implementation is necessary to break the cycle of policy failure.

Despite the considerable expansion in the number and extent of marine protected areas during the past century, coverage remains limited amid concerns that many marine protected areas are failing to meet their objectives. New estimates of global marine protected area, based on the database maintained by Sea Around Us, revealed a degree of progress towards protecting at least 10% of the global ocean by 2020. It is estimated that > 6,000 marine protected areas, covering c. 3.27% (12 million km2) of the oceans, had been designated by the end of 2013. However, protection is generally weak, with c. one-sixth (1.9 million km2) of the combined area designated as no-take areas (i.e. fishing and other extractive activities are prohibited). Additional large tracts of ocean will need to be protected to reach the 10% target, and we investigate hypothetical scenarios for such expansion. Such scenarios offer a one-dimensional measure of progress as they do not address aspects of other global targets, such as Aichi Target 11, which will help to ensure that marine protected areas meet their objectives and achieve conservation outcomes.

Current global marine protection targets aim to protect 10–30% of marine habitats within the next 3–5 years. However, these targets were adopted without prior assessment of their achievability. Moreover, ability to monitor progress towards such targets has been constrained by a lack of robust data on marine protected areas. Here we present the results of the first explicitly marine-focused, global assessment of protected areas in relation to global marine protection targets. Approximately 2.35 million km2, 0.65% of the world's oceans and 1.6% of the total marine area within Exclusive Economic Zones, are currently protected. Only 0.08% of the world's oceans, and 0.2% of the total marine area under national jurisdiction is no-take. The global distribution of protected areas is both uneven and unrepresentative at multiple scales, and only half of the world's marine protected areas are part of a coherent network. Since 1984 the spatial extent of marine area protected globally has grown at an annual rate of 4.6%, at which even the most modest target is unlikely to be met for at least several decades rather than within the coming decade. These results validate concerns over the relevance and utility of broad conservation targets. However, given the low level of protection for marine ecosystems, a more immediate global concern is the need for a rapid increase in marine protected area coverage. In this case, the process of comparing targets to their expected achievement dates may help to mobilize support for the policy shifts and increased resources needed to improve the current level of marine protection.