The problem with measuring progress in treatment

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For most patients in the hospital or going through a crisis, the question of prognosis is first and foremost on their minds. Unfortunately, limited research continues to target prognosis and the lifespan of illnesses.

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. Those creative pathways can empower people with a diagnosis to be motivated in their recovery and truly track, on 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.

In Article 31 Mental Health Clinics, clinicians complete treatment plans which, if in congruency with the state regulations, will include measures. These measures allow the practitioner to track, in very real terms, through person-centered language, gains made by patients in the course of their treatment. Every three months, a review of these plans is completed, and new measures are either added or removed, hopefully, revised to reflect new life circumstances, either relapse or ongoing recovery.

Clinicians are encouraged or need, to be aware of ongoing changes within the patient’s clinical picture, during weekly, bi-weekly, or medication management sessions, on a monthly perhaps quarterly basis. But how is progress truly measured by clinicians and by patients alike?

In evidence-based practice (EBP) measures are usually more module-based, prescribed, and very much mapped out in highly ornate and complex sets of measurements, tools, etc. Measures beyond the capacity of most Article 31 clinics in terms of rigor, efficacy, and reproducibility, given the poor retention rates of staffing, no-show’s by patients who miss sessions, either due to symptom interference, poverty, transportation issues, and all the circumstances free-standing clinics suffer from compared to mobile teams, and more organic treatment settings that target connectivity issues, and systemic problems associated with extreme rural or urban settings.

For most therapists, either in private practice or in this Article 31, there are methods of tracking progress without using complex, cumbersome, and expensive treatment modalities to implement and train staff.

This can be done in several ways – keeping in mind that measures need to be person-centered, and in the terms of the consumer – basic progress can be tracked by client reporting, collateral reporting, and direct observation in a session of a client’s mental status using a standard MMSE (Mini-Mental Status Exam).

But, ultimately, these measures – both the under-developed Article 31’s clumsy and, at times, disorganized 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 unidisciplinary collaboration, become impossible and present yet another impasse to treatment.

The DSM-5, and other manuals, research, can only provide generic research for diagnosis. Meaning, research, and the prognosis is measured in broad strokes, and is based on studies, populations, and circumstance, but is limited in their ability to truly put numbers and language around a person-centered prognosis for people with a mental health disorder.

About the Author

J. Peters

J. Peters is the Editor-in-Chief of Mental Health Affairs.

Award-winning book author and Bold 10 Under ten award recipient J. Peters, LCSW. Through his work as a Licensed Clinical Social Worker. Mental health therapist and disability rights advocate Mr. Peters fights for those without a voice in various care systems, such as the New York City Department of Social Services, the New York State Office of Mental Health, or the city's Department of Corrections.

Mr. Peter's battle with Schizophrenia began at New London University in his last semester of college. Discharged from Greater Liberty State Hospital Center in July 2008, Jacque's recovery was swift but not painless and indeed brutal after spending six months there.

He has published several journal articles on recovery and mental health and three books: University on Watch, Small Fingernails, and Wales High School. He is also a board member of the newspaper City Voices. Mr. Peters currently sits on the CAB committee (Consumer Advisory Board) for the Department of Mental Health and Hygiene in NYC and the Office of Mental Health (OMH) as a peer advocate.

Owner of Recovery Now in New York, a private psychotherapy practice, Mr. Peter's approach is rooted in a foundation of evidence-based practices (EBP). Jacques earned a master's degree in Social Work from Binghamton University and worked as a field instructor for master's and bachelor's level students in NYC.

He is blogging daily on his site mentalhealthaffairs.blog, Mr. Peters regularly writes articles relating to his lived experience with a mental health diagnosis.

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