As a front-line worker in the system, it’s frustrating to hear these same fixes, especially evidence-based practices, promoted time after time as though they are some silver bullet that will provide good outcomes at lowered cost.

I especially love the part about having consumers fill out long assessments and then updating the data weekly or monthly. Anyone who has actually worked with say schizophrenic or bi-polar consumers knows that long assessments and constant data collection often exacerbate paranoia and are sometimes impossible if someone is in the midst of psychosis.

And one of the dirty secrets of evidence-based treatments is that often, the results only involve people who actually complete the course of treatment. Studies of evidence-based treatments often have high attrition rates (common in all mental health treatment), that call into question whether they are all that more effective than other treatments.

And a common straw-man in this debate is the “freudian analysis” argument. In all my time working in social services, I have yet to meet a single therapist who practices freudian analysis. Practitioners who do generally serve private clients who can afford to pay for that kind of intensive long-term treatment.

Most practitioners these days are well-versed in cognitive behavioral theory and have what’s known as an “eclectic” approach. Which simply means that to the best of our ability, we tailor treatment to individual clients based on what we honestly think will get the best results. There are more and less data-driven ways to do this, but very few therapists are so inflexible as to think that applying one rigid model will provide good results across the board.

Much of the real problem, I believe, stems from this country’s lack of commitment to health care and families in general. Mental health problems often begin in childhood as stressors in conjunction with some biological/genetic factor. We don’t address this very well here- we leave families to fend for themselves and as a culture favor competitiveness, which leaves little for people who are not up to the competition. Social Darwinism is still the underlying belief system that allows people to underfund services that would help treat people with mental disorders.

Much of the current push to overhaul the system is really an acknowledgment of this- that mental health services will not be adequately funded in the near future and that we must make do by providing short-term treatment and hoping for the best.

Oh, and all that paperwork- it actually subtracts time that could be spent on client care. That is a major reason why practitioners hate it.