Using What Works and NOT Using What Does Not Work

Recently, my research team published a scientific commentary in the Canadian Medical Association Journal dealing with an important mental health concern. We conducted an assessment of the information dealing with psychological debriefing in schools and found that there was no substantive evidence to support the use of that kind of intervention following traumatic events. We also found that the best available evidence in studies of adults showed that these type of interventions were not helpful, and indeed in some studies turned out to be harmful (see: Psychological debriefing in schools, www.cmaj.ca Online publication, January 4, 2010)...

Yet, these interventions have been very popular and used so frequently that they have become commonplace. Who has not heard the news on the radio that grief counselors have been dispatched to a school after a traumatic event?

This raises a very important issue. That is, before we start wide-scale mental health interventions we need to be pretty sure that they work and we need to be really sure that they do not cause harm. If we put programs into place that do not work we are creating a false sense of security and using scare resources; money and people, to no good end. Furthermore, because of our investment in such programs we may be less interested in considering other options – options that may actually work. In other words, what seems like a good idea may not be a good idea and if that gets codified or ingrained in an organization or institution it may have more negative than positive consequences.

So, what is to be done? First, when we do get solid substantive evidence that what we are doing does not really work, is not cost effective, could be done better in a different way or may cause harm – we should stop doing whatever that is that we are doing. Sounds simple but it is not so easy. Usually because there has been a big investment in the initial program and there may even be a big industry and local champions pushing for its continuation. Second, before putting in a program we should demand solid substantive evidence that the program really works and that it causes no harm. Third, if we decide to put programs in without the kind of evidence we need to have, we better make sure that we also provide the kind of independent and unbiased research that is needed to help us determine if the program works or not, if it is cost effective and it does not lead to harm!

We have to do the right thing, not just do something.

--Stan