Doing the right thing in mental health programs
Posted on 22/01/2010 | 1 Comments
Arguably, the area of mental health is the newest domain of health in using independent, empirically valid and scientific approaches to determining what works, for whom, at what financial cost and with what potential harm. Perhaps because of this “newness” we seem to spend a lot of unproductive time arguing or discussing what we should be doing and frequently confusing opinion with evidence and often not understanding that all evidence is not equal.
The Health Development Agency of the National Health Service (United Kingdom), in a 2004 critical review of youth suicide prevention programs provided the following four criteria to be used in the application of all mental health programs:
1 – Apply good and effective interventions
2 – Avoid ineffective interventions
3 – Eliminate harmful interventions
4 – Facilitate public accountability
These seem pretty reasonable to me.
The problem we seem to have is making sure we do each of these things. This is especially a difficulty when our pet theories or personal perspectives do not stand up to independent, substantive and appropriate scrutiny. Yet these are the things that we need to do.
So here is a suggestion. Before implementing any mental health program can those people charged with doing that simply tic off each of these four criteria. Have you clearly and with the proper and most substantive type of evidence demonstrated that the interventions are good and effective? Are you using programs or other interventions that have none or inadequate evidence of effectiveness? Are you sure that your programs or other interventions do not cause harm? Have you been open with the public about the effectiveness, cost effectiveness and safety of all the programs and other interventions that you have in place?
If not, why not?
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This is a great set of comments and rings very true.
I totally agree that scientists (just like everyone else) have their biases and foibles. After all, scientists are human beings too! But science is different than scientists.
The scientific method is the most objective frame that we have by which to evaluate and predict. Science is not about finding truth. It is only about being less wrong most of the time. The scientific method (experimental design and mathematics) gives us the ability to test what we believe. The scientific method is not used to prove something is correct, on the contrary, the scientific method is designed to prove that something is not correct! It is designed to test what is called the “null hypothesis”. It takes ideas that come out of left field (or wherever else they come from) and puts those ideas to an independent test.
t does not drive our beliefs. It does however challenge our beliefs. In that way it is self-correcting. Of course scientific inquiry and understanding lives within a wider social context. That is one of the great features of science.
But gravity is gravity, social context notwithstanding. And thus it is nasty, brutish and long. As Brecht said, (something like this) - the purpose of science is to save us from everlasting error.
By Christina Carew on May 11th
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Anci said...
Very interesting article, I am very happy to read it.
Thank you for sharing with us.
Comment made on September 11th, 2010
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