“Evidence Based Mental Health in the Real World: Promises, Challenges and Future Directions”
An evidence-based decision about a specific intervention (either pharmacological or not) is not determined only by its demonstrated efficacy and tolerability; it may vary from one patient to another depending on individual clinical circumstances (sex, age, clinical history, etc) and personal preferences. However, ‘evidence’ is not necessarily ‘evident’. Evidence is anything presented in support of an assertion. This support may be strong or weak, but it is the closest that we can get to the truth itself and the only objective starting point we can use for our clinical reasoning. We need all good quality, available data to justify our rational choice; otherwise patients will be treated according to mere opinion. This is the reason why I strongly disagree with opponents of Evidence Based Mental Health who say that it is the wrong paradigm to answer our routine clinical questions. On the contrary, given the inevitability of biases and inaccuracies in the scientific literature, we have a simple choice: we can either make the best use of the available evidence or dismiss and ignore it. Clinicians (and patients and carers) should favour the former approach and reject nihilism. Valid conclusions can be drawn from a critical and cautious use of the best available, if flawed, evidence. Also ‘the best available evidence’ implies the continuous update and progress of scientific knowledge, doubting, testing and retesting previous findings. Scientific knowledge in medicine can develop and increase only if there are researchers, clinicians, patients and public who strive to see things from a different perspective, always pursuing the truth (which almost always means avoiding easy answers). Evidence Based Mental Health should be seen as a tool to engage new generations of psychiatrists and psychologists to develop and implement the evidence-based approach into daily clinical practice.