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Assessing the evidence for effectiveness 

Assessing the evidence for effectiveness
Oxford Textbook of Community Mental Health

New treatments are constantly being introduced to all forms of psychiatry and for most of these the setting in which the treatment is administered is not of special importance. Thus the introduction of a new and effective drug for a mental disorder will require similar testing in hospital, community, or other settings and does not require special description here. However, all treatments given in the community have a common problem associated with them, compliance, or what is now more appropriately termed ‘concordance’ or ‘adherence’ (Mullen, 1997). Because treatment in the community can rarely be supervised satisfactorily, a great deal depends on the motivation of individual patients to continue whatever intervention is being given without the need to be closely monitored. Increasingly, therefore, the evaluation of community treatment is going to involve, 1) some check on whether the treatment is being given appropriately and 2) if not, whether additional treatments are able to be introduced to improve concordance and adherence. New treatments to improve compliance have now been introduced for the major psychoses and shown to be effective (Kemp et al., 1996; 1998; Perry et al., 1999) and these approaches are likely to impinge increasingly on those working in the community and be amongst the areas of competence being evaluated for such workers.

The word ‘evaluation’ is now being used increasingly to describe any type of description of an intervention, and more and more it is being used inappropriately with regard to community treatments. The word ‘evaluate’ is a mathematical expression originally used to give a numerical value to something which previously had no such value. It is still used in this sense in related expressions such as ‘evaluable’, but increasingly it has been broadened in use to describe any form of assessment, whether or not it is quantified accurately.

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