everything is being cut they've actually managed to get more
psychological therapies. This is the evidence of the power of effective
campaigning.
I think a lot of people think it's a fucking joke and I agree. I am
totally passionate about mental healthcare so please don't get me wrong.
I just prefer that people live longer too. Homelessness is perhaps the
most distressing experience though I'm sure there are others that rate
up there. Are they going to provide therapists for the homeless or are
they going to feed, clothe and shelter them? I'd like to do all of that
but if I only had a little money I'd prefer to make sure they're fed
first. And fed properly because that's going to have more of a positive
impact on their physical and mental health.
But we need to keep people happier during a sad time. I'm afraid the
high quality evidence doesn't show that psychological therapists are
capable of doing this in an effective way. Once publication bias has
been compensated for and only high quality trials selected the effect
size becomes tiny. Effect sizes in mental health in general are tiny
compared what's considered significant or effective in physical
healthcare. Even psychopharmaceutical research.
But let's understand the research properly. Psychological therapies are
better than absolutely nothing. High quality research trials compare an
active treatment to an inert one. In pill research it's a dummy pill. In
PT research it's an intervention that has no theoretical basis. It's
things like befriending or social skills training that are compared to
treatment from an trained, experienced psychotherapist. It's not that
psychotherapy is useless, it's the effectiveness of the controls that is
the problem.
Or perhaps it's not the problem. It's the fucking solution. Part of the
power of the controls used in trials is simple human contact. This is a
powerful thing to make people happier. It's so powerful that I read some
prof geezer in America bitching about the research contacts the placebo
control group in the STAR*D trial got. Idiot. Those are totally
necessary for a proper trial because the active group got them as well
(in an experiment there should only be one variable and everything else
is kept the same). He was bitching because the placebo group once again
proved so effective in the world's highest quality antidepressant trial
that the active group didn't do significantly better than the placebo.
But there's the point: social contact.
The second element in my opinion relates to the Hawthorne effect applied
to healthcare. Google it but the Wiki definition doesn't explain what I
read in a book on evidence in mental healthcare. The effect happens in
healthcare because people go see a doctor and feel better. This is
irrespective if the treatment the doctor gives. It's just the effect of
seeing a doctor, a person who's given the status as a healer.
This leads to two ideas that are alternatives to training and employing
expensive psychotherapist.
No comments:
Post a Comment