Evidence of what?

Mental Health Nursing,  Jul/Aug 2000  by Faulkner, Alison

• E-mail
• Print
• Link

Evidence is a significant theme running through current debates about mental health practice. Underpinned by NICE (the National Institute for Clinical Excellence), the government's policy on quality in health care is to encourage the critical examination of what works, and for whom - an apparently reasonable and logical enterprise.

However, we do not always undertake the same critical analysis of the nature and sources of the evidence under consideration, nor of the outcomes we are using to evaluate it with.

In evidence-based practice, the evidence at the 'base' is generally founded on the `gold standard' of research theory, the randomised control trial (RCT).

Researchers and clinicians alike tend to assume that big is beautiful and numbers are best. Objectivity is taken for granted and the scientific experiment is considered the only source of 'real' data. Yet the experience of all types of treatments and services in the real world is fundamentally subjective. Also, no data is completely objective; processes of selection and editing occur in even the most 'scientific' methods of data collection and analysis.

As with any research, the evidence we obtain is only as good as the questions we ask. Are we asking questions appropriate to service users, the people for whom the issue is most crucial? If the questions are meaningless or inappropriate to start with, the results can take us in quite the wrong direction. Clinical effectiveness, if it only addresses a narrow definition of `symptom relief', may fail to take into account certain aspects of people's lives - issues that may be crucial in determining an individual's decision to continue treatment.

Mental health service users are increasingly becoming involved in such issues of evidence and the definition of outcomes. In recent research at The Mental Health Foundation, the qualities people most valued about the input of their CPNs or keyworkers, concerned their accessibility and continuity, and their ability to convey respect and compassion.

These qualities were valued above the nature of the support or intervention on offer (e.g. support with developing coping strategies, with practical matters, information and symptom management). But, it is unlikely that service users will listen to, or engage with, these other issues, if the quality of the human interaction causes them to feel dismissed in themselves.

Evidence for effectiveness is indeed important when considering the merits of different treatment interventions. But, before implementing the results of the latest RCT, all practitioners would do well to heed the evidence of service users. At the end of the day we are human beings, not experimental subjects responding to the latest treatment. Our evidence, as service users should be a vital and central element in the move towards evidencebased practice.

Editorial board member Alison Faulkner is a mental health researcher and a service user

Copyright Community Psychiatric Nurses Association Jul/Aug 2000
Provided by ProQuest Information and Learning Company. All rights Reserved