Interdisciplinary parity: Which is the right clinical pathway forward?
As a social worker, I sit on a vast, layered, and profoundly broader body of knowledge, theoretical understanding and foundation of information than some other more narrow-focused disciplines out there in mental health. This is why I believe it is up to social workers, prosumers (people with lived experience and professional training) and other more ornate backgrounds and experiences to jettison research into the next era. In order to truly help people, the mental health community needs to better define what ‘help’ means for people with a mental health disorder. We work in a multidisciplinary field rife with different approaches and different languages all targeting the same issue, treating mental illness or mitigating the impact of the disorder by providing a service to people in the public mental health system. Maybe this is the problem. By in large, practitioners are working in isolation at the micro level within a larger system of care. This is a bit counterintuitive to reform an already mixed up way of managing the entire way we do things in mental health.
In the end, there are so many different perspectives on what constitutes best practice in mental health treatment. So, what is and is not best practice will continue to be hotly contested until the structure of the system is changed as well as what the system defines as common indicators of progress and what a good outcome is and is not.
Thinking about progress is critical for both consumers and practitioners, as well as researchers and those with a vested interest in creating space in the field for creative pathways to empowering people with a diagnosis to be motivated in their recovery and truly track in their own terms, their success in treatment.
In therapeutic settings, therapists monitor the progress of their patients. This is done in several ways, depending on the type of therapy (for example, the modality, setting and treatment milieu) and needs to also be taught to consumers of treatment, so both practitioner and patient can work more closely and in greater clinical harmony. For most therapists, in private practice, or in the public mental health system, there are already methods of tracking progress, without using complex, cumbersome, and expensive treatment modalities to implement and train staff.
But, ultimately, these measures, are clumsy and at times, disorganised approach to tracking recovery, and its converse, the over-intellectualized, ornate, and highly prescribed new, hip, modalities, which are so difficult to train with enough latitude to reach the mass base of practitioners, that identifying a common language to measure client and collateral reporting during interdisciplinary meetings, or even indiscipline collaboration becomes impossible and presents yet another impasse to treatment.
The DSM-5, and other manuals, research, can only provide generic research for diagnosis, Meaning, research and prognosis is measured in broad strokes, and is based on studies, populations, circumstances, but is limited in its ability to truly put numbers and language around a person-centred prognosis for people with a mental health disorder. This is a problem for people who want to know what’s ahead, plan for it, and what to expect, in their own terms, while living out their life with a diagnosis. Underneath diagnosis, and even less researched, is rate-of-recovery, and the speed (duration of illness and the symptoms) of a person to experience progress and relief from their symptoms. I recommend, without further delay, immediate research and studies charged with the measurement of recovery, in very real terms, that truly allows patients and practitioners to know what to expect, when to expect it, and plan so problems can be addressed before they occur.
I am very serious about the set of propositions I am laying out here. This is part of a restatement of claims I have made before, but this article needs to signal a giant tectonic shift in how we do things in our field. So, who really is charged with appraising the clinical value of our research these days? Who is really validating the claims researchers are making? Scholarly work, studies, published papers – all these outlets and mediums for disseminating good information in our field have bias. We must accept and own these biases. Peer-reviewed work, blinded, however we tell ourselves our work is pure, intellectually and ethically solvent, needs to be overhauled if not torn down at the very ground floor we built the discourse on before we can call ourselves truly unbiased, and platonic in our commitment to unassailable research in mental health. Let’s be totally honest here.
Endorsement of peer work in academia is as rife with political intrigue and back door funnelling of money and funding as the White House.
The difference with academia is that we refuse to talk about it. And there are no television dramas depicting our ethical and moral battles in the wings of institutions and library halls. Similar to the perseverance of our patients, we must redirect the very meaning-making and re-target the areas of research which aren’t talked about: the missing or underdeveloped areas of research which continue to confound and contest the very bodies of knowledge we hold as truly incontestable.
Well, if we are really being honest about what we do in mental health, we would do just that. No modality, no study, no manuscript for submission is truly above reproach. There are taboo areas of how we do things as researchers that are problematic. If we do not overhaul and turn academia, pedagogy and practice on its head sooner rather than later we are headed for disaster. I would hazard to say the destruction of this field as we know it as an accepted discourse of intellectual enquiry. So, before it is too late, ask questions, continue to go against the current, until the very armamentarium of new research moves with us towards a brighter, healthier vistas of tomorrow.