What is the evidence really showing us, and what does it mean for tomorrow’s mental health services?

Jim van Os

Much of the language and practice of mental health care is based on apparently simple concepts, for example that symptoms are caused by mental disorders, that evidence from randomised controlled trials are required to inform evidence-based guidelines that can be applied to individual patients, that the highest intensity of care is admission to a hospital bed, that professionals have no lived experience of mental illness, that severe syndromes are of 'biological' and mild syndromes of 'psychosocial' origin, that the technical ingredients of psychotherapy are more important than the therapeutic relationship, that effectiveness of interventions is reflected by reductions in symptoms, that there is an urgent need for a medical model of prevention of mental illness, that  deep brain stimulation, transcranial magnetic stimulation and manipulation of the immune system hold major promise for the treatment of mental illness, and that the organisation of mental health care is best placed in the hands of large and complex organisations that negotiate contracts based on production parameters and quantitative outcome measurements. 

Close analysis of these assumptions shows that their apparently strong and even unassailable logic is increasingly being questioned. Scientific demystification of professional knowledge and practice suggests that a critical transition may be approaching that requires new concepts, language, science and practice to address the issue of mental distress in populations.