World Mental Health Special: How can we work our interventions better
The World Mental Health on October 10 is a recognition of the global importance of mental health. What is the relevance for Canada?
First: The slogan ‘1 in 5’ is not enough
We need to move beyond this oversimplification. Imagine saying to people with heart problems that they have a ‘physical health problem’ in common with people who have joint problems.
People who are burdened by social anxiety disorder have different needs from people who suffer from schizophrenia. None of the popular mental health campaigns in Canada or Ottawa recognise this vital fact. However, the World Health Organisation is clearly working to define the different needs.
Being specific about mental health disorders is important
There are different types of mental problems. At present we have diagnoses as in DSM 5 (Diagnostic and Statistical Manual Version 5) or ICD 10 (International Classification of Diseases Version 10) which define these. Many professionals and clients may not prefer diagnoses, but this is just a way of communicating and specifying the nature of the problem in brief. Each individual has different needs the best evidence is for individualised treatments.
Talking about the right intervention is important
We often hear people say that they want to see a psychologist, psychiatrist, psychotherapist, counsellor et cetera. This is understandable but we need to further specify the type of intervention or treatment that would provide solutions to the specific mental health conditions. For example, only 5 therapies are recommended in treatment guidelines for PTSD (post-traumatic stress disorder) and these are: Prolonged Exposure Therapy, Cognitive Therapy, Cognitive Processing Therapy, EMDR (eye movement Desensitisation and Reprocessing) and Narrative Exposure Therapy. Only Cognitive Behavior Therapy is recommended for the treatment of social anxiety disorder. The evidence for these is clearly established and in England these are national recommendations from the government.
Access is important
Having access to mental health assessments and treatments is important. They should be based on carefully designed and navigable care pathways for each mental health problem. A pathway for access to care in ADHD (Attention Deficit Hyperactivity Disorder) would be different from a pathway for generalised anxiety disorder (or excessive worrying).
Walk-in centres and emergency rooms are should not be the default options even though they serve their purposes.
The IAPT (Improving access to Psychological Therapies) services in England showed that self-referral for therapy was associated with good outcomes.
Speed of access is important
Access for therapy within 6 weeks of referral is also associated with good outcomes (see IAPT England). In our team’s clinical work, we strive to meet these standards.
Training and supervision are associated with good outcomes in psychotherapy
We want to clearly differentiate the training for licenses to practice, which is regulated by various colleges (e.g. Social Work, Psychology, Physicians, Psychotherapists) from the actual training in specific psychotherapies. The largest implementation of evidence-based psychological therapy (IAPT, England) which receives a million referrals each year has shown that over and above the professional training, therapists need to train specifically in the different types of therapy. The duration of such training should be at least one year and be associated with weekly supervision using the therapist’s audio recorded work.
All our therapists and trainers have gone through this and continue to attend weekly training and supervision as learning and competence are a part of ongoing quality management.
Measuring outcomes every session must be the gold standard
All too often clients attend therapy with no measurement of outcomes. Not doing these overestimates the overall therapy outcomes. We partner with greenspace, a Canadian company based in Ontario, to measure client’s outcomes using carefully selected questionnaires. These can be completed weekly online or in therapy sessions so both the therapist and the client can keep track of their progress and work constructively towards the client’s goals.
Happy Mental Health Day!
About the Author:
Dr Sanjay Rao is an experienced teacher and Associate Professor of Psychiatry at the University of Ottawa In 2018 he was awarded a Fellowship of the Canadian Association of Cognitive Behavioural therapy for his contribution to CBT in Canada. He has received an award from the Department of Health, UK for CBT development. He is the Director of Unified CBT training.