What Is an Evidence-Based Practice in Mental Health?

Evidence-based practice in psychology or mental health involves the application of treatment based on research substantiating its efficacy. It also involves the clinician's experience and observations as well as the patient's characteristics. Treatment should not be based on an established psychologist's view of what's best but on positive results shown from research. The research should be combined with the psychologist's empirical knowledge, or observations and experiences, and evaluation of the patient's circumstances.

History

• The movement for evidence-based practice in mental health followed a similar movement in medicine in the 1990s. According to Professors Bonnie Spring and Sarah Altman writing in the journal "Behavior Therapy," physicians discovered that patients with similar medical problems were receiving different and, in some cases, incorrect treatment. Only about 15 percent of treatments were based on evidence. The movement began for research to establish results. Spreading to the behavioral sciences, the Society of Behavior Medicine formed a standing committee for evidence-based treatment in 2004.

Research

• Perhaps the most significant component of mental health EBP is research. Trials need to be conducted for inadequately tested therapies, and existing research needs to be expanded on therapies in wide use, writes Tori DeAngelis in an article for the American Psychological Association. Distinctions need to be made between treatments backed by solid evidence and those not well tested or even harmful. Treatment evidence can be ranked from the most to the least significant.

Clinical Expertise

• Along with the research, clinical expertise is very important in determining treatment. Data indicates, for example, that "seasoned clinicians are better than younger professionals at making diagnoses" and modifying them when new information is introduced, writes Tori DeAngles. Experience also means selecting and streamlining treatments as a patient's situation changes. Treatment can't be selected only because research supports its efficacy, says Dr. Carol Goodheart, co-chair of APA's task force developing a policy on EBP; it must be evaluated and perhaps modified by empirical considerations.

Patient Characteristics

• A third key element in mental health EBP is patient characteristics, the newest area in the movement and the most in need of study and evaluation, according to APA's task force. Little research exists, for example, on such client groups as ethnic minorities, some of which have been underserved in mental health care. The research that exists indicates that some minorities don't respond well to traditional treatments, but more data are needed.