IMPLEMENTING EVIDENCE-BASED SERVICES with CLINICAL

COMPETENCIES in COMMUNUNITY MENTAL

HEALTH

The TEN COMMANDMENTS of COMMUNITY MENTAL HEALTH

Robert Paul Liberman

Stockholm Sept 27, 2002

1.THOU SHALT NOT MAKE THE SAME GARMENT FIT ALL

Indvidualize treatment planning and service…

Individualize treatment planning and service by linking intervention with phase and type of disorder, disabilities, strenghts, resources and personally relevant goals

2. THOU SHALT NOT SEPARATE TREATMENT (PSYCHOPHARMACOLOGY)

FROM REHABILITATION

(PSYCHOSOCIAL SERVICES)

Comprehensive and coordinated services require integration…

Comprehensive and coordineted services require integration within a single practitioner or frequent and high quality communication among members of a multidisciplinary team

3. THOU SHALT INTEGRATE ASSESSMENT WITH

TREATMENT IN CLINICAL PRACTICE

Optimal treatment of individual patients...

Optimal treatment of individual patients, as well as inseminating the art of psychiatry with scientific progress, requires initial and ongoing measurement of symptoms, medication adeherence, psychosocial functioning and goal attainment

4.THOU SHALT ASSURE CONTINUITY OF CARE WITH CLINICAL AND

ADMINISTRATIVE ACCOUNTABILITY

Psychosocial and pharmacological treatments must be bridged across time and place by systems of care

Psychosocial and pharmacological treatments must be bridged across time and place by systems of care; modus, locus and focus of services require planning, organization, communication, liasion, consultation among agencies and individuals providing care

5. THOU SHALT USE EVIDENCE-BASED PRACTICES

”Doing your own thing” in clinical work will no longer ”cut the lutefisk”

”Doing your own thing” in clinical work will no longer ”cut the lutefisk” or ”bring home the bacon (dollar, euro, krona, pound, peso, ruble)”

6.THOU SHALT NOT SERVE ALL WHO KNOCK ON YOUR DOOR OR

RING YOUR PHONE

Prioritization of services for those with greatest disabilities...

Prioritization of services for those with greatest disabilities and for whom there are evidence-based services will help to improve clinicians´ competencies and reduce expenditures of the mental health system

7.THOU SHALT BE STEADFAST IN DESTIGMATIZING MENTAL ILLNESS

Destigmatizing must be an ongoing responsibility...

Destigmatizing must be an ongoing responsibility of practioners. Stigma busting can be accomplished bu judicious self-disclosure of mental illness and sucessful treatment by practioners and celebrities, as well as by consumers; demonstrating how treatment makes outcomes more positive and predictable; engaging non-compliant and symptomatic patients in treatment; reducing violent behavior by the mentally ill; and hiring stable and recovered consumers as paraprofessionals

8.THOU SHALT AVOID PRIVITIZATION AND MANAGED

CARE BY FOR- PROFIT ORGANIZATIONS

Managed care has been a colossal failure in the USA...

Managed care has been a colossal failure in the USA for the seriously mentally ill and a calamity for psychiatrists´autonomy. Beware of saving money while losing quality of care, but psychiatrists, other mental health professionals and stakeholders and their organizations must be proactive in cost attainment and accountability od cost-effectiveness

9.THOU SHALT BECOME POLITICALLY ACTIVE, NOW AND

FOREVER MORE

The financial and political tail always wags the clinical dog...

The financial and political tail always wags the clinical dog. Psychiatry and mental ilness have always been beholden to society as much as influenced by medicine and science

10.THOU SHALT DISSEMINATE AND MULTIPLY YOUR

EFFECTIVE METHODS OF TREATMENT

Overcoming obstacles to adoption of evidence-based, ”best practices” is aided ...

Overcoming obstacles to adoption of evidence-based, ”best practices” is aided by social, psychological, economic, organizational, legal and political tools