By Cynthia Bulik
On Wednesday April 4 at the iconic Varsity Theater in Chapel Hill, CEED was honored to sponsor a screening of the powerful documentary Going Sane. Director Josh Sabey was in attendance and joined Christine Peat from CEED, Cynthia and Ed Binanay, and myself in a discussion panel after the movie to address questions from the audience on the topic of evidence-based mental health care.
The documentary is particularly powerful for me as several of my former mentors (Stephen Hinshaw, PhD from UC Berkeley and Walt Kaye, MD from UC San Diego) and colleagues (Bill Pelham, PhD) spoke passionately about the importance of delivering evidence-based care in psychiatry and psychology. They were joined by powerful voices of patients and family advocates who had been through the complicated labyrinth of finding evidence-based care—some with tragic outcomes. Unfortunately, the mental health field lags far behind other areas of medicine in requiring evidence-based practices. This makes it incredibly difficult for parents and caregivers to sift through available information to make informed decisions about the best treatment for their loved ones.
Part of the evening was spent clarifying terms related to evidence-based practice.
Evidence-based treatment: Evidence-based treatment (also known as empirically supported treatment) refers to those psychological interventions that have demonstrated efficacy for a specific condition through rigorous, high quality research of (e.g., the collective evidence of multiple randomized controlled trials).
Evidence-based practice: Evidence-based practice is a method of clinical decision-making that combines the research evidence for a particular treatment (i.e., is the treatment empirically supported?) with patient characteristics and clinical expertise. The American Psychological Association defines evidence-based practice as, “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” Thus, evidence-based treatment is a component of evidence-based practice but does not solely determine the clinical decision making. (The interested reader can find more information here).
Evidence-informed treatment: This phrase often gets used when therapists pick and choose features of various evidence-based treatments, but don’t actually deliver the treatment in a format that reflects how it was developed and tested in randomized controlled trials. For example, a therapist might use “a little bit of CBT” but not actually deliver a comprehensive course of the treatment as it was meant to be delivered.
Cynthia and Ed Binanay brought a wealth of both professional and personal information to the panel, via their work in the health care system, and the challenges they faced in finding care for their son who in addition to a congenital heart condition was also diagnosed with schizoaffective disorder. Together with audience members, they illustrated how critically important it is to advocate on behalf of your ill loved ones. The Binanays also emphasized how important it is to talk about mental illness, even though you might find that some of your friends may distance themselves from you. By speaking about mental illness, you destigmatize it, and you’ll make new friends—ones who are understanding and supportive.
Christine Peat from CEED helped describe some of the evidence-based treatments that are available for mental illnesses, in specific how cognitive-behavioral therapy is applied to the treatment of eating disorders.
A core message of the film and the panel was to be informed consumers of mental health care. Ask questions. Be involved. Advocate. If you missed the screening, or would like to watch it again or share it with someone who could benefit from the messages, you can rent or buy it on Amazon. Additionally, if you are interested in hearing more about the documentary and the importance of its message, we encourage you to listen to Josh being interviewed on WCHL and Dr. Bulik being interviewed on WUNC’s The State of Things.
We ran out of time for questions during the panel and promised to address any unanswered ones in our blog. Here are a few of the questions that we did not get to on the eve of the screening.
1. Please give examples of evidence-based treatment other than CBT and family involvement when treating mental illness.
a. This is a great question! There is a fantastic publicly-available resource from The Society of Clinical Psychology that has compiled all of the various evidence-based treatments for mental illnesses. The website allows you to search for treatments by name or by mental health diagnosis. Another excellent source for learning about mental health evidence-based practices is the website of the Substance Abuse and Mental Health Services Administration (SAMHSA) https://www.campbellcollaboration.org/
2. Support group at UNC Oasis charges money…via deductible on insurance. This should be changed. Money seems to be the motivating component even for a family support group.
a. We agree that mental health services are far too limited in terms of their scope and availability, particularly for those who are underinsured or uninsured. Many of us in the mental health field continue to advocate for broadening this scope and are active in politics to help enact these changes. In the meantime, there are free resources available to those living in specific counties (see list of NC county managed care organizations) and some practices do offer free services. For example, local eating disorder specialist Tammy Holcomb offers a free support group for those with eating disorders and the Carolina House offers a free support group for families of those with eating disorders.
3. Is there a newsletter for this area consolidating protests for mental health, fundraisers, workshops, etc.
a. While we are currently unaware of any specific newsletters that consolidate this type of information, we encourage our readers to learn more about various mental health efforts through the following well-respected organizations: