Mental health public policy: Common Sense vs Science
I’ve got a bad feeling about Senate Bill 3562 introduced by Senator Bernie Sanders (I-VT) on September 19. Like me, you may have missed the birth S 3526, which was introduced to “reauthorize and improve the Older Americans Act of 1965, and for other purposes.” I have been slightly preoccupied with the Detroit Tigers and Derek Jeter’s busted ankle.
Besides, who could possibly oppose a bill to reauthorize the improve the Older American’s Act of 1965, which created the Administration on Aging and all kinds of entitlement programs for the elderly? I began wondering, too, about the phrase “and for other purposes.” What does THAT mean? So, I read the proposed bill and noticed that when it comes to funding mental health programs for the elderly, someone had decided to preface all services for seniors – including mental health services – with the phrase “evidence-based.” For example,
(E) in paragraph (23), by striking ‘‘mental health services’’ and inserting ‘‘evidence-based mental health, chronic condition self-care management, elder abuse, neglect, and exploitation prevention, and falls prevention services’’;
Who could possibly oppose “evidence-based” services? Using our tax-dollars to pay for services with proven track records is a good thing, right?
Well, yeah, when it comes to services for conditions that are easily studied. For example, it’s easy to gather evidence on the health benefits resulting from meal-delivery programs for low-income seniors who live alone and do not drive. How hard is it to prove the success of fall-prevention programs that provide non-slip bath mats and installation of grab bars and rails?
But how do you prove that mental-health services work? Where is the empirical evidence showing that having your apartment cleaned or laundry done or just a simple visit improves mental health? I don’t know. I DO know that even if there is a way to measure that, state and local agencies are cutting research from their budgets in favor of maintaining program services.
The Centers for Disease control defines evidence-based public heath as: “the development, implementation, and evaluation of effective programs and policies in public health through applying principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models.”
Sounds impressive but adjectives such as “effective,” “systematic” and “appropriate” scare me when they are in the hands of politicians. What is “effective” to a Democrat may not be “effective” to a Republican these days.
The Centers for Disease Control has created the Behavioral Risk Factor Assessment Program, which collects data from states on the mental health of older adults. God bless, they have collected “surveillance data that can be used for priority setting and as the foundation for developing public health programs.” With these data they have created three “evidence-based” programs: IMPACT (Improving Mood-Promoting Access to Collaborative Treatment); PEARLS (Program to Encourage Active Rewarding Lives for Seniors) and Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors).
Still, I have this nagging suspicion that the phrase “evidence based” will be used to justify cuts to programs. Look what happened last month when the Veterans Administration decided that it would not pay service-dog benefits to vets who suffer only with post-traumatic-stress-disorder and not a vision, hearing or mobility-related injury.
Why? Because “the only evidence submitted in support of this assertion were anecdotal accounts of subjective benefits, including: decreased dependence on medications; increased sense of safety or decreased sense of hyper-vigilance; increased sense of calm; and the use of the dog as a physical buffer to keep others at a comfortable distance. Again, we do not discount commenters’ personal experiences, but we cannot reasonably use these subjective accounts as a basis for the administration of VA benefits.”
In other words, there is not enough evidence proving that service-dogs assist vets with PTSD. God forbid the VA pay a benefit that isn’t evidence based. So, vets with PTSD who want some help covering the expenses of owning a service dog.
I don’t know why government officials have suddenly gotten all sciency on us. I am all for weeding out wasteful government spending and pork-barrel programs that benefit major campaign contributors. But we need to keep a close on cuts to mental health programs and services that someone in Washington has decided are not “evidenced based.”
The brain is the final frontier of medicine. We do not yet know how or why the brain responds to certain stimuli, whether it is medication, a friendly phone call or the soft coat of the golden retriever. Science isn’t quite there yet. Until then, we’re going to need to substitute evidence with a little common sense. Or in the case of policy makers in Washington, a lot of common sense.
Stapleton, C. (2012). Mental health public policy: Common Sense vs Science. Psych Central. Retrieved on April 19, 2015, from http://blogs.psychcentral.com/depression/2012/10/mental-health-public-policy-common-sense-vs-science/