Evidence in Mental Health Care

Evidence in Mental Health Care

Evidence in Mental Health Care

Evidence in Mental Health Care

Synopsis

Mental health care increasingly faces a challenge to be 'evidence based'. This book evaluates a range of different research methodologies and types of 'evidence', and includes a presentation of different methodological approaches.

Excerpt

From its very beginnings, psychiatry has been particularly vulnerable to swings of diagnostic and therapeutic enthusiasms. Its history is permeated by ingenious speculation and hazy guesswork, and its achievements have often been a mix of serendipitous discovery and intuitive hunch. Its disasters have contributed to the stain of stigma that smears so much of contemporary public and professional thinking about mental health and illness. Down through the years, various classificatory systems have been ingeniously elaborated and applied with a dogmatic zeal and rigidity more worthy of fundamentalist theologians than dispassionate clinicians. Treatments of the most demanding kind—one thinks of insulin coma therapy, leucotomies, regressive electro-convulsive therapy, daily psychoanalytic psychotherapy extending over many years—have been energetically peddled with scant reference to any valid and reliable information concerning their actual effectiveness.

It is something of an irony, therefore, that, along with the rest of medicine, psychiatry faces a fashion which demands that everything that doctors and other health care professionals do is done soundly and judiciously according to the best available evidence concerning its effectiveness. Evidence-based medicine, as the various contributors to this book demonstrate, has grabbed the attention of policy makers, service planners, health administrators, medical and paramedical therapists, and clinical and academic researchers, and it has done so because of the growing awareness of the shaky foundations on which so much of the expensive enterprise that is mental health care rests.

The questions raised are manifold and disquieting. What are we as health care professionals actually doing, as distinct from what we say we do and what we think we do? Reading the psychiatric textbooks, one would be forgiven for believing, for example, that the prescribing of a specific drug for a specific condition is the norm of everyday clinical practice. in actual fact, half of patients are receiving more than one psychotropic drug at any one time, while one in three are taking three of more. Yet, there have been few reliable studies undertaken that have examined the efficacy of such drug-taking in various combinations. Why are we doing what we do? Why, for example, do

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