Why Don’t We Have Effective Mental Health Services?

Abstract

I thought I would never write this in ‘‘public’’ but one of the paradoxical problems with our mental health services is that they are not visibly harmful. Most of the research shows that treatment as usual (TAU) is neither harmful nor effective. Ineffective mental health services do not usually produce dramatic negative outcomes. In most cases the client will drop out of services, especially in the public system where the no show and dropout rates are phenomenally high. Certainly there are suicides and assaults, and sometimes killings. However these incidents are usually attributed to inadequate supervision or custody rather than to ineffective treatment. Unlike the surgeon who leaves an instrument in a patient or a plumber who leaves a leaky fitting, there is no trail left by unsuccessful treatment. But poor outcomes are not buried only because they are insufficiently dramatic or visible. We hide the ineffective services from ourselves and the public by not collecting information that measures their effectiveness. Even the clients may not be aware that they have received ineffective services.