Guest Post: Exploding mental health myths will help more people, says Counselling Outcomes Reviewer.

There is an entire body of knowledge and research in the Counselling & Mental Health Field that is being almost universally ignored, and the cost of this self-induced ignorance by industry is hindering vulnerable people accessing the help they most desperately need, says a Counsellor with over 18,000 hours of Practice experience.

Stephen Taylor, Director of Relationship Matters Ltd has spent the past ten years reading and reviewing nearly 70 years of national and international literature on Counselling Outcome Research, and says that the gulf between the “what works” evidence and how mental health intervention is practiced in New Zealand is “almost inter-planetary”.

For example, for someone to be considered competent as a Counsellor, Psychotherapist, Mental Health worker, or Psychologist, the embedded industry practice norms mandate a minimum of 100’s of hours of practice, clinical supervision, and membership to a professional association.

However, over and over again, the “what works” literature designates these practices as peripheral and irrelevant to achieving positive client outcomes.

Length of clinical experience, type of qualification, gender and cultural matching between client and practitioner, model of practice, more industry funding, and ongoing professional development training also contribute almost nothing to achieving positive client outcomes – it’s like there is a collective “group-think” in our industry that insists that these things work for clients, when the actual practice evidence says that they don’t” says Mr Taylor.

“Since 1994, there has been 50 official reports written on the sorry state of mental health in NZ, and the voice of the service consumer is consistently being drowned out by “experts”. Formal client-directed measurement of client outcomes is absent in almost all counselling and mental health service providers in New Zealand, and is not taught as a discipline in any meaningful way at tertiary level.

This is puzzling, as formal client outcome measurement can roughly double intervention efficacy, and halve treatment costs”.

"Until industry sides with the "what works" evidence (which is a significant body of work that is absent from the current national discussion on mental health), nothing of significance will change for vulnerable people seeking mental health assistance, regardless of which door they walk through" says Mr Taylor.

Key Mental Health Outcome Research Evidence Findings:

* The burden born by people with mental health problems is second only to cancer, with depression alone resulting in a 70% loss of productivity.

* Approximately 10% of adults deteriorate in care, between 14% and 25% of children are worse off following treatment, and serious client deterioration is recognized in only one-third of presenting cases.

* Factors related to the therapeutic relationship (i.e., empathy, collaboration, affirmation, genuineness) have a far greater impact on outcome (7:1) than treatment approach, adherence to treatment protocol, type of qualification, professional affiliation / membership, length of practice time, gender, or arbitrary, non-evidenced based industry-rated competence.

* The “who is doing the treatment” matters much more than “what model of treatment” is being used.

* Rapid and dramatic change (first 5 visits) occurs in as many as 40% of people and is maintained at two year follow up.

* There is a 90% chance of treatment failure if there is no change between the 2nd and 8th session visit and as many as 25% of people remain in treatment while experiencing no measurable benefit.

* Separating intake from treatment results in higher drop out, lower and longer treatment response, and higher costs.

* Whilst the majority of individual practitioners can demonstrate some efficacy (however small) in their work, around 16% of practitioners achieve outcomes significantly below average.

* Less effective practitioners rate empathetic understanding more highly as a professional/personal attribute than more effective practitioners.

* If the clients of the least effective clinicians were assigned to average practitioners, an additional 15% of clients would achieve clinical recovery.

* Around 16% of practitioners consistently achieve outcomes significantly above average, and more effective practitioner’s rate resilience and mindfulness more highly as a professional/personal attribute.

* Professional self-doubt and an “error-centric attitude” are associated with better outcomes. Some therapists are simply better at what they do then other therapists, but there is a significant reluctance by industry to either formally measure staff efficacy with clients, or identify who in their agency achieves the best client outcomes.

* When therapists receive feedback that clients are deteriorating, they discuss it with clients about 60% of the time; make efforts to assist with other resources about 27% of the time; adjust therapeutic interventions 30% of the time; vary intensity of services 9% of the time; and consult with others (supervision, education, etc.) 7% of the time.

* Therapist attitudes toward soliciting and using feedback vary and influence results, and therapists who value and formally measure client feedback achieve better outcomes.

* When asked, 92% of clients say they like the use of formal client-directed outcome measures in treatment care, yet almost no mental health services in New Zealand utilise these measures.

* More money does not equal better outcomes for clients, but formally measuring the efficacy of service from the client’s perspective can dramatically improve outcomes, and increase spending efficiency.

* Prior to allocating additional funding, funding agencies (including Government) should first require an independent client-informed outcomes review of the agency requesting additional resource. Agencies who demonstrate effective client outcomes should then receive more money, and the agencies that cannot demonstrate effective client outcomes should receive less money, or be de-funded. The savings made from de-funding less effective agencies can then be re-invested with more effective agencies, for a zero additional overall cost.

* The total amount of formal training hours required by a competent practitioner to learn effective skills-based training to then assist people in need in the mental health field is 50 hours, and whilst models of practice account for just 1% of contribution to effective client treatment outcome, the majority of tertiary practitioner training focuses on models of practice, when the “what works” evidence affirms that all models work equally well (or not).

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