The role of "evidence" in recovery from mental illness.
Evidence-based practice (EBP), a derivative of evidence-based medicine (EBM), is ascendant in the United States' mental health system; the findings of randomized controlled trials and other experimental research are widely considered authoritative in mental health practice and policy. The concept of recovery from mental illness is similarly pervasive in mental health programming and advocacy, and it emphasizes consumer expertise and self-determination. What is the relationship between these two powerful and potentially incompatible forces for mental health reform? This paper identifies four attempts, in the mental health literature, to delineate the role of "evidence" in recovery. One is the strong version of evidence-based practice-an applied science model-and three others address weaknesses in the first by limiting the authority of probabilistic findings. The paper also offers a fifth version, based on the concept of communicative accountability, which is derived from Habermas' work on communicative action. The fifth version responds to the other four and emphasizes learning, disclosure and respect in clinical and other helping relationships.
Tanenbaum
Sandra J
SJ
School of Public Health, The Ohio State University, 459 Cunz Hall, 1841 Millikin Road, Columbus, Ohio 43210, USA. tanenbaum.1@osu.edu
D019317:Evidence-Based Medicine; D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D010817:Physician-Patient Relations; D016032:Randomized Controlled Trials as Topic