Doing the right thing in mental health programs
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?