Beyond Best Practice: How Mental Health Services Can Be Better

“… massive amounts of time and energy are spent defining the scope of clinical practice and standardizing service delivery. Despite our best intentions … rules ultimately replace our client’s reality. Defining their problems, and regulating the methods used to treat them, trumps what clients want and how best to achieve it.”

In the Foreword to Beyond Best Practice: How Mental Health Services Can Be Better (by Birgit Valla and David Prescott), Dr. Scott Miller has written:

“… professional mental health finds itself in an … absurd place. The need for help is obvious … Every day clients present for treatment to rectify a wrong, get a new start, feel better, and move on. To service the demand, any reasonable person would conclude that it is best to address directly, with each and every client, what they want to be different as a result of meeting with us. Instead what happens? Year after year, massive amounts of time and energy are spent defining the scope of clinical practice and standardizing service delivery. Despite our best intentions … rules ultimately replace our client’s reality. Defining their problems, and regulating the methods used to treat them, trumps what clients want and how best to achieve it.

As it is, 40 years of outcome research documents the futility of the field’s furious yet misplaced efforts. While the number of standards, ethical guidelines, diagnoses and treatment methods has exploded, almost no attention has been paid to the most important determinant of therapeutic success: client engagement. The temptation to think that the field is making huge strides in improving the quality and outcome of care is understandably strong, However, the proof is indisputable: costs are increasing, dropout rates remain high, and overall clinical outcomes have not improved appreciably from one year to the next.

At length, clients do not care about what we think about what we do or how we do it. Rather, they want what they want. And how do we figure out what ‘it’ that clients want? … that question is the most important of all.”