Trend towards Evidence Based Practicies: Will it Promote Recovery?

Trend towards Evidence-Based Practicies

The Trend Towards Evidence-based Practices: Will It Promote Recovery for People with Psychiatric Disabilities?

Mental Health News Spring 2002 Issue

by Harvey Rosenthal, Executive Director

New York Association of Psychiatric Rehabilitation Services

In recent years, national and state mental health agencies and organizations have come to make the use of ‘evidence-based practices' one of their top priorities in the delivery of services to Americans with psychiatric disabilities.

Evidence-based practices, which are considered to be services and supports that have been consistently proven by research to help people in their recovery, have been the theme of several major recent studies, conferences and funding initiatives. As such, their use represents a major national and state trend that will effect all of the stakeholders in our mental health service community, from consumers/survivors to family members, from service providers to state and local mental health agencies.

So, what is this trend towards evidence-based practices about...and what implications can it have for proponents of recovery, rehabilitation and rights for New Yorkers with psychiatric disabilities?

From 1992-8, the National Institute of Mental Health funded a study, implemented by the Patient Outcomes Research Team (PORT), to develop and distribute recommendations for the treatment of schizophrenia based on ‘existing scientific evidence." One of the strongest findings of the PORT study was, as Principal Investigator Dr. Anthony Lehman noted, that fewer less than half of all Americans receiving treatment for a diagnosis of schizophrenia received what research had shown to be the proper doses of psychiatric medications with the right mix of ‘appropriate psychosocial interventions,' which they considered at the time to include employment supports and case management services.

In 1999, the U.S. Surgeon General's report on mental health further emphasized the great gap that existed between the kind of care the research found to be most effective..and the kind of care that most Americans received, concluding that "services and programs based on scientific advances in treatment are not routinely available" to meet the needs of individuals with psychiatric disabilities.

Subsequently, prominent national researchers like Dr. Robert Drake have focused national attention on 6 particular evidence-based treatments, citing that "...research strongly supports:

the use of specific medications prescribed in specific ways as well as the use of psychosocial interventions such as
supported employment,
various approaches to illness self-management,
family psychoeducation,
case management based on the principles of assertive community treatment, and
substance abuse treatment that is integrated with mental health treatment."

(I've adapted this quote into a bulleted format to highlight the 6 practices).

Over the past year, the NYS Office of Mental Health has sought to put evidence-based practices on the front burnerin New York, highlighted by a special ‘Best Practices Conference' it hosted last June in Brooklyn and a new special ‘Winds of Change' presentation it will be rolling out this across the state this year.

OMH has highlighted what is being called the ‘quality chasm', urging us to look at instances where some services are being overused, underused or misused and calling on service providers to shift their practices to highlight consumer-centered, timely, effective and efficient approaches.

While most groups have well appreciated the notion that the services people with psychiatric disabilities receive should be the best ones possible and ones with clear evidence to back up their effectiveness, the trend towards evidence-based practices has raised a number of provocative questions from the recovery and rehabilitation community.

Dr. William Anthony, the nation's leading proponent of psychiatric rehabilitation, has pointed out that evidence-based practice research to date has not focused enough on "recovery-related process and outcomes (e. g., having choices, feeling respected, positive changes in meaningful work, self esteem, empowerment, etc.)." Anthony has urged that "the concept of evidence-based practice must be broadened to include ‘encouraging and promising but not yet confirming' evidence-based practices."

For example, a number of groups here in New York and across the country have advocated for the inclusion of increasingly popular and effective self-help approaches. In that spirit, peer support services proponent Shery Mead M.S.W. has pressed for the inclusion of "research that is grounded in the outcomes of...alternative (peer support) practices," adding that"it is crucial that we teach and practice approaches that allow us to put..(these) values into action."

NYAPRS has been encouraged by the NYS Office of Mental Health's responsiveness to these concerns. Recently, OMH has issued its priority list of evidence-based practices for adults that have added:

	self-help and peer support services and
	post-traumatic stress disorder treatment to the 6 evidence-based practices already endorsed above.

Further, OMH has supported the restructuring of the ‘illness self-management' practice into

wellness self-management education (featuring a strong emphasis on approaches that teach individuals to develop their own personalized recovery plan featuring a number of self-help and ‘alternative' approaches, like Mary Ellen Copeland's Wellness Recovery Action Plan.

What's next? Look for the following over the next few months:

OMH staff will be featuring the ‘Winds of Change' presentation at a number of forums across the state.

NYAPRS in conjunction with PEOPLe, Inc. will be hosting a broad number of regional and local presentations on the call for quality and the nature and use of evidence-based practices.

The Mental Health Empowerment Project will be featuring workshops on EBPs in each of their upcoming spring regional conferences.

The NYS Council for Community Behavioral Healthcare will feature an evidence-based practices track at its upcoming June conference.

And this year's NYAPRS 20th Annual Conference will feature both an ‘exemplary services' track and a special September 10 Institute Day program, "Making the Case for Peer Support Services as an Evidence-based Practice,' that will feature national figures like Dr. Edward Knight, Dr. Daniel Fisher, Joseph Rogers, Larry Belcher, Dr. Jean Campbell, Dr. Jean Dumont, Shery Mead and Laura Prescott.

This "Mental Health E-News" posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights.

To join our list, e-mail us your request and, where appropriate, the name of your organization to NYAPRS@aol.com.

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