An interview with Skyland Trail Charles B. West Chief Medical Officer Raymond J. Kotwicki, MD, MPH
What is evidence-based psychiatric treatment?
Evidence-based medical treatment means that, as a physician, you look at the research literature to determine, according to reputable studies, which treatments successfully help patients improve and recover and which treatments do not.
Just because someone has the latest-and-greatest thing with bells and whistles on it doesn’t mean that it’s actually helpful or the best thing to do.
Many people may assume that all doctors do this, but that’s not always the case. To really qualify as an evidence-based program, organizations and physicians must intentionally build a commitment to evidence-based treatment into their treatment models and practices, constantly reviewing new data and outcomes and integrating new information into practice.
Just because one study shows that something is good for diagnosis or outcomes, doesn’t make it evidence-based. It’s really my job as chief medical officer to determine if and when the community of psychiatric physicians believes a new therapy or technology has been adequately scrutinized and replicated by enough researchers with no vested interest in the results to be deemed a new standard of care. That designation can take time. Just because someone has the latest-and-greatest thing with bells and whistles on it doesn’t mean that it’s actually helpful or the best thing to do… although it may be the most expensive.
Why is using evidence-based medical practices important in mental health care?
If I had a family member or loved one in need of a treatment facility, my number one concern would be that they use evidence-based practices. If you are investing your time, energy and resources in a recovery program, you should be confident that the program is offering things that research has shown to be effective.
When you or a loved one is suffering, and the programs or treatments you’ve tried have not worked, it’s easy to get frustrated and look for a “magic bullet.” But it’s not a wise thing to do. It doesn’t produce good results, and, ultimately, when magic bullets don’t work, people may become frustrated or hopeless and give up. We know that really effective treatments for almost all mental illnesses exist, and that, with effort and investment, most patients can recover. That can require a lot of work, though. We use evidence-based best practices to make that work pay off.
How does Skyland Trail implement evidence-based therapies?
Our recovery communities are built around this idea. We use evidence-based psychotherapeutic modalities like cognitive behavioral therapy for people with depression and anxiety and dialectical behavior therapy for people with borderline personality disorder because, in the medical research literature, that is what has been shown to be the most effective in helping people with those illnesses.
A comprehensive psychiatric and psychosocial diagnostic assessment at admission helps us match each patient with a recovery community and an individualized recovery plan built around the therapies research indicates are most appropriate for that set of diagnoses, symptoms and goals. Ongoing assessment helps us make adjustments as needed.
This tailored, individualized approach is absolutely essential. If you don’t understand someone’s diagnosis or motivation, you might be using an evidence-based treatment but for the wrong patient. More than just knowing which treatments work, we have the systems in place and good judgment to match each patient with the right treatment.
We have a very scholarly staff at Skyland Trail, so our clinicians and leadership know how and why it’s important to scrutinize the medical literature. And we’re not just reading the results of studies; we go through primary medical literature – the studies themselves – and we look at how the participants are similar to or different from our patients. Then we discuss whether or the not the results are applicable to the patients and services we have at Skyland Trail.
How does Skyland Trail incorporate new treatments?
We are continuously working on quality improvements, and when new therapeutic approaches are shown to be effective and meet the needs of our patients, we make sure our staff receives training on how to implement them, and then incorporate them into our program.
For example, we recently started practicing cognitive remediation therapy (CRT) for patients with cognitive decline due to previous untreated mental illness. Before we invested in CRT, we completed a comprehensive literature review of research showing CRT was useful, we engaged in our own CRT-based research, and scrutinized the results before incorporating it into our programming. The technology and “buzz” about CRT weren’t enough. We had to put it to the test. That is true evidence-based practice.
Through our outcomes research activities, we are starting to see positive results. And we will be able to contribute our outcomes data to the body of knowledge about how and when these therapies work best.
We provide excellent treatment now, but that doesn’t mean we can’t be even better. I call it the “n +1” philosophy. If we’re at level n, that’s great, but what’s n+1? What’s next? If an organization isn’t improving, it’s regressing, because there’s new data in the medical literature every day. Staying fresh and constantly learning new ways to do things is one of the best things about practicing medicine.