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In mental health care, turning research findings into clinical directives is fraught with difficulties.
ABSTRACT: Evidence-based practice (EBP) is the subject of vigorous controversy in the field of mental health. In this paper I discuss three distinct but interrelated controversies: how inclusive the mental health evidence base should be; whether mental health practice is a variety of applied science; and when and how the effectiveness goal in mental health is defined. I provide examples of evidence-based policy in mental health. These controversies pertain as well to general medicine. To the extent that they remain unresolved, evidence-based policy making may lead to ineffective and limited care.
EVIDENCE-BASED PRACTICE (EBP) refers in a general way to the application of scientific research findings to the treatment of individual patients. Evidence-based medicine (EBM) is one field of EBP; evidence-based mental health care is another. EBP is ubiquitous. It has a powerful presence in the clinical literature and in plans for improvement of professional education, health care management, and health policy making. One commentator finds that physicians "can't kick over a bedpan without hearing the phrase 'evidence-based medicine' rattle out."1 EBP is more than a version of health care practice, however. It is a movement, like the outcomes movement before it, of scientists, public officials, private payers, and advocacy groups that seek to establish a new knowledge regime in health services.2 This involves not only the funding and dissemination of clinical scientific research but also "epistemological politics," by which some knowledge-and some knowers-are privileged in the consulting room and policy arena.3 One proponent of EBP portrays the movement as "a revolution... which asserts the supremacy of data over authority and tradition."4 EBP can also be viewed as asserting which data are supreme and pursuing the movement's own authority in health care.
This paper focuses mostly on psychologists-who share the field of mental health with psychiatrists, counselors, social workers, psychiatric nurses, and so forth-but not only as a concession to space. Rather, psychology is a primary locus of the EBP debate, and psychologists share many concerns with other professionals in the field. In psychology, EBP influences the research priorities of funding sources, the editorial policies of scholarly journals, the program agendas of scholarly conferences, the content of approved treatment lists...