but as anyone knows who has copied a fellow pupil’s homework, this can end in tears! The Service believes, it disseminates ‘best practice’ by networking clinicians together. But there is no evidence that this is the case.Those most vocal or most eminent are likely to hold sway. Ensuring the dominance of eminence not evidence-based treatment. This runs the risk of creating a totalitarian culture in which it is not possible to express a dissenting opinion. The power-holders then control what is published in journals/publications. But like the Russian regime of the 1980’s they would vigorously protest that they are engaged in Glasnost (0penness).
The use of artificial intelligence in mental health is an exemplar, ‘par excellence’ of copying. The authors of IESO claim that its interactive text messaging service for clients, is based on the careful selection and analysis of client-therapist exchanges and that they have determined what works. If indeed this were the case it would make the provision of mental heath services much cheaper for the NHS (as well as making a nice profit for IESO). But no such reliable database with real-world outcomes e.g being free of a disorder as assessed by an independent observer for at least 8 weeks, has been determined.There are no published papers to substantiate a real-world effect. Without fidelity checks there can be no assurance of the translation of an evidence-based treatment to routine practice.
I recently read James Davies’s book Sedated: How Capitalism Has Created the Mental Health Crisis, (2021) Atlantic Books, without necessarily buying into his thesis that Capitalism is the arch-enemy, it is certainly the case that financial factors ( NHS Talking Therapies cost the taxpayer £ 2 billion a year), coupled with the opportunity to exercise unbridled power has produced a dysfunctional mental health system. But the problems are not confined to primary care, I recently saw a client who has had 4 years of secondary care treatment in relation to child abuse, the records revealed no objective audit. This echoes the National Audit Offices failure to provide any credible independent assessment of mental health services. There is an inherent believe that the mental health services must be all too the good because the clinicians are well-intentioned. But if they had stopped long enough to listen to my client he would have told them ‘I need a new approach, I have plateaued’. In reality there is no Glasnost. Let’s no be copy-cats.
Dr Mike Scott