Evidence-Based Mental Health
PSYC 377
Structure of the Presentation
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2.
3.
Describe EBP issues
Categorize EBP issues
Assess the quality of ‘evidence’ by review of research
methods
Why do we need evidence?
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Policy need to be informed by evidence on
the SIZE and NATURE of the mental health problems
AND
 what is known to be EFFECTIVE
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Evidence-based Practice
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Roots in Evidence-based Medicine – assessing the
effectiveness through experimental controlled trails
Evidence can come from sources such as trials to surveys
to focus groups, sometimes it might come to light as a
result of public or media pressure or both
Filtering ‘good’ and ‘bad’ information is CRITICAL
Evidence-Based Practice
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Process of using the best available scientific evidence to
understand what works best
Process of systematically finding, appraising, and using
recent research results as the basis for making clinical
decisions
Use of clinical interventions that have been :
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Evaluated by well-designed clinical research studies
Published in peer-reviewed journals
Consistently found to be effective
RCTs
Evidence:
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Randomized Control Trials (RCTs) as the ‘gold standard’ for providing evidence
In mental health, RCTs target understanding causal relationships between variables
(what causes schizophrenia?)
RCTs:
Randomized controlled trials are used to examine the effect of interventions
on particular outcomes such as death or the recurrence of disease.
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RCTs are sometimes not feasible, necessary, appropriate, or even sufficient:
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Patients are randomized to receive or not receive the intervention
Any significant differences between groups in the outcome event can be
attributed to the intervention and not to some other unidentified factor.
Study the effect of a risk factor such as smoking cannot ethically be addressed
Randomized controlled trials are not appropriate for cancer screening, a
situation in which the outcome is rare and frequently occurs only after a long
delay.
Before doing RCTs, smaller studies should be used to examine the
predictive value of the test against some accepted standard.
Quasi-Experimental Research
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Similar to RCTs but they specifically lack the element of
random assignment to treatment or control.
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In quasi-experimental designs the researcher controls
assignment of patients to the treatment condition
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Some criterion other than random assignment might be
used (eg. an eligibility cutoff mark)
Evidence-based Mental Health Practice
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Increase empiric basis and effectiveness of clinical practice
by helping clinicians and clients select the most accurate ,
valid information
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Help clients identify their own strengths to alleviate or
diminish symptoms or states
Levels of Evidence
1.
2.
3.
4.
5.
6.
Transparent results (peer-reviewed and accessible to
public)
Based on empiric research protocols (randomized
control trial, quasi-experimental studies)
Used steps that are standardized and clearly explained
so that it could be repeated
Produce replicable results
Fidelity scale (showing the research was replicated in
similar way to the original research)
Produce meaningful results/outcomes
A-B-C-D Level of Evidence (WHO)
Type A: What works is known, how it works is known,
repeatability is universal
Type B: What works is known, how it works is known, but
repeatability is limited
Type C: What works is known, repeatability is universal but
how it works is not known
Type D: What works is known, how it works is not known,
repeatability is limited
Note: Health promotion is based on Type B level of
evidence.
Research Methods and Levels of Evidence
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Level 1:
 Systematic Reviews using meta-analysis,
 2 randomized control trials
 Cohort or case control studies
 National consensus panels on RCTs
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Level 2:
 No meta-analysis
 One RCT or research showing dramatic effect or national consensus panel
recommendation based on controlled studies
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Level 3:
 Quasi-experimental:
 Uncontrolled trial or observational study with more than 10 persons
 Descriptive studies
 Expert consensus guidelines
Levels of Evidence
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Level 4
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Level 5
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Clinical opinion
Non-controlled studies without comparison groups
No consistently positive measured outcomes
Not research based
Level 6
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Anecdotal case reports
Unsystematic clinical observation or correlational studies
Descriptive reports
Case studies
Single subject designs
Demonstrates consistently bad outcomes for a particular population
Level 7
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Emerging best practices or promising practices
Group Exercise
Where to go for Mental Health Research
Resources
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Websites:
Cochrane Collaboration (Mental Health)
 Campbell Collaboration
 Center for Evidence Based Medicine
 PubMed
 Clinical evidence
 National Health Society for Reviews and Dissemination
 Inventory of quality measures for mental health care
 World Health Organization Reports
 Draft of guidelines for systematic reviews of health promotion
 Global Program on Health Promotion Effectivenness
Guidelines:
 Expert Consensus Guidelines
 EBP Practice Guidelines
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