Evidenced-Based Practice In Mental Health
In this section you can learn about the treatment approaches which research has shown are effective for various psychological conditions. The therapists at Harley Therapy are trained in a number of modalities and are guided by these evidenced-based recommendations.
NICE Guidelines for Common Psychological Problems
The National Institute for Health and Care Excellence (NICE), formerly The National Institute for Clinical Excellence, is now undertaking the work of bringing evidence-based guidance and standards to the social care sector in addition to its existing responsibility for public health guidance and standards, hence its name change.
NICE aims to improve outcomes for individuals using public health and social care services. It does this in a number of ways. Firstly, NICE provides evidence-based guidance to aid practitioners in delivering a high-quality service. Secondly, NICE develops quality standards and performance metrics for health and social care practice. Thirdly, NICE provides a range of information services for commissioners, practitioners and managers within health and social care; such information can benefit mental health sufferers and their families, enabling them to understand what treatment they should be offered.
There are some broad ranging recommendations that can be applied to all mental health practice. Firstly, approved and trained professionals should be involved in assessment and treatment. There are many different types of mental health professionals which can cause confusion.
Mental healthcare professionals who can offer psychological help include clinical psychologists and counselling psychologists (accredited by the British Psychological Society), psychotherapists and counsellors (accredited by the British Association for Counselling and Psychotherapy), and art therapists (Registered with the Health and Care Professions Council – HCPC).
Occupational therapists (Registered with HCPC) can offer a wide range of skills and independence development.
Registered mental health nurses (RMN) can often be trained in counselling as well as being able to prescribe medication.
Trained psychiatrists can offer drug-based treatment. GPs can also offer some drug- based treatment or refer a patient to a psychological/psychiatric professional.
Some healthcare professionals also specialise in certain fields, for example, working with young people, those with personality disorders, or use specific treatment approaches such as cognitive behavioural therapy (CBT).
NICE also highlights that the management of any co-morbid mental health conditions is important for full recovery. For example, some individuals suffer with more than one mental health condition at a given time and these can often be interlinked with one another. All presenting problems should be considered using evidence-based treatment.
The general recommendation is to seek help and start treatment at the earliest possible stage.
The NICE guidelines can often be lengthy documents with a great deal of content. This particluar document aims to provide succinct information about evidence-based practice recommendations for different mental health issues.
Evidence-Based Treatment Recommendations for Mental Health Issues
Alcohol dependence and harmful drinking
The first point of treatment offered should be psychological intervention (e.g. cognitive-behavioural therapies, behavioural therapies or social network and environment-based therapies). Behavioural couple’s therapy should be offered to service users who have a partner who is willing to participate in treatment. If psychological therapy is unsuccessful or service user specifically wants drug therapy then this should be considered in conjunction with psychological therapy.
The generalised anxiety disorder pathway follows a number of steps for treatment. If one step does not alleviate the problem then treatment should move to the next step.
Step 1: Education and active monitoring. Step 2: Individual guided self-help and psycho-educational groups. Step 3: High-intensity psychological intervention (CBT or applied relaxation) or drug treatment.
The panic disorder treatment pathway suggests the individual and healthcare professional should discuss options and mutually agree upon a treatment option. These include psychological help (CBT), drug treatment and self-help.
Obsessive compulsive disorder (OCD) or body dysmorphic disorder (BDD) treatment depends on the severity of the condition. The low-intensity approach is CBT including exposure and response therapy. The moderate intensity approach is higher-intensive CBT including exposure and response therapy or drug therapy. The high-intensive approach uses a combination of psychological and drug therapy. Individuals who do not respond to such treatment should continue to access specialist treatment services and possibly supported accommodation, enabling living skills to be developed. Treatment of children with OCD/BDD should include guided self-help and support and information for families.
Post-traumatic stress disorder (PTSD) treatment should consider the involvement of families, providing practical and social support and educating a service user about PTSD. Psychological interventions can be trauma-focused CBT and trauma-focused eye movement desensitization reprocessing (EMDR). Drug therapy should not be used as a first line treatment as psychological treatment is preferable.
Treatment can include supporting families (guided self-help, education of drug misuse, suggesting support groups and promoting effective coping resources). Advice on reducing risk, delivering brief motivational interventions and providing information on help groups should be given to the service user. The various treatment options should be discussed with the service user (e.g. abstinence-oriented, maintenance-oriented and harm-reduction interventions). A range of psychosocial interventions are effective in the treatment of drug misuse including contingency management, behavioural couples therapy, and a range of evidence-based psychological interventions for the treatment of co-morbid mental health problems (CBT and psychodynamic therapy).
Treatment should include physical monitoring, education, evidence-based self-help and risk management. Psychological treatments for eating disorders include cognitive analytic therapy, CBT, interpersonal psychotherapy and focal psychodynamic therapy. Family interventions which focus explicitly on the eating disorder are also recommended for treatment. Drug therapy should not be used as the sole treatment for eating disorders.
People who suffer with depression can be treated psychologically and/or pharmacologically, dependent on the severity of the condition. Low-intensity psychosocial interventions or group- based CBT may be offered. High-intensity psychological interventions (CBT, interpersonal therapy, behavioural couple’s therapy, counselling, behavioural activation, psychodynamic psychotherapy) and drug treatment can be offered. Inpatient treatment should be considered for people who are at significant risk of suicide, self-harm or self-neglect. A further treatment method for life-threatening depression can include electroconvulsive therapy. Family therapy may be offered to children suffering with depression. Children should not be offered antidepressant medication except in combination with a concurrent psychological therapy. Children should not use St John’s Wort as a treatment method; there are no trials in young people upon which to make a clinical decision for St John’s Wort to be a depression treatment.
Bipolar is recognised as a long-term condition and should be treated on a long-term basis. Sufferers should be provided with specialist expertise in diagnosis, pharmacological, psychological, social, occupational and educational interventions that are available. Treatment is often based primarily on psychotropic medication along with psychological and psychosocial intervention. A further treatment method for life-threatening bipolar can include electroconvulsive therapy.
It is important to ensure that practice considers the overall treatment and care. Treatment should be tailored to the individual, the type of personality disorder and the presenting problems. Brief psychological interventions should not be offered to sufferers. Some evidence-based treatment approaches include dialectic behavioural therapy and mentalisation-based therapy. Drug therapy should not be solely used and there are many marked restrictions on the use of medication (e.g. anti-psychotic drugs should not be used for mid to long-term treatment for borderline personality disorder).
CBT, family intervention and art therapies should be offered to schizophrenic sufferers. Drug therapy should also be offered to individuals. The professional, patient and their carers should discuss the psychological, psychosocial and pharmacological options and work in partnership.
Treatment of self-harm should be psychological, focusing on the causes and should be tailored to the individual. Approaches may include cognitive-behavioural, psychodynamic or problem-solving. Harm reduction, developing coping strategies and discussing less destructive alternative behaviours should also be considered. Treatment should target associated conditions by providing psychological, pharmacological and psychosocial interventions relevant to the condition.
Follow this link to read the complete NICE guidelines to mental health and behavioural conditions.