By Max E. Guttman, LCSW
Mental health clinicians have long been asked to measure the change in their patients to demonstrate treatment progress. This is typically accomplished through standardized testing, such as the Mental Status Exam (MSE). The MSE is a structured assessment conducted by healthcare professionals to evaluate an individual's cognitive and emotional functioning. It aims to gather information about a person's mental health and determine their current mental state. However, recent research has called into question the usefulness of such testing.
Until recently, clinicians have relied on the MSE and similar testing to measure the progress of their patients in treatment. Testing that research is beginning to suggest that “progress” is more subjective than clinical. Examples of subjective elements include appearance, behavior and speech. The MSE also relies on the subjective judgment and interpretation of the clinician. In the end, the clinician’s professional expertise and training plays a crucial role in making these judgments.
With the rise of telehealth, patients are more connected to the computer than ever. Programs like Therapynotes.com and other electronic health record systems test other measures to determine treatment progress. These outcome measures, e.g. (CAGE-AID, a substance abuse screening tool, GAD-Y, an anxiety screening tool, PCL-5, a PTSD screening tool, etc.) are inserted into a patient’s record without interrupting a therapy or med management session. Still, despite these advances, measuring the change in mental health treatment remains misleading in clinical practice. Moving forward, exploring alternative ways of thinking about progress will become critical.
Measuring progress in mental health treatment is essential because it allows treatment providers to objectively assess the impact of their interventions and determine whether more intensive or different treatments are necessary. It also allows for tracking individual patients’ progress over time and provides a benchmark to gauge the effectiveness of various interventions. These measurements can also inform decisions about the appropriateness of treatments or other factors affecting mental health outcomes.
Measuring progress can help to identify patterns of change. Identifying these patterns can help clinicians to assess their practice and develop more efficient and effective treatment plans. It can also help to pinpoint areas where further research is needed.
Several factors can distort measuring progress in mental health treatment. The first is the timing of assessments. Often, assessments are performed at regular intervals, such as monthly or quarterly, instead of on an as-needed basis. This could lead to discrepancies in the results, as the patient may have had an event or a change in circumstances that impacted the evaluation results.
Another factor is the use of the same assessment tool for all patients. This can result in oversimplified evaluation results, as each patient may have a different set of issues that require different interventions and assessments. It can also lead to a lack of individualized care, as patients are not receiving tailored treatment plans based on their needs.
The effects of mental health treatments can be challenging to measure, as they involve physical and psychological changes. It is easy to measure some physical changes, such as weight loss or muscle gains, but psychological changes can be vaguer and more difficult to measure accurately.
To get a more accurate assessment of progress in mental health treatment, clinicians should avoid the use of standardized tests, or use it solely to establish a baseline, and embrace more personalized forms of evaluation. A personalized form of evaluation should be directly tied to a patient’s treatment goals. For example, if a patient’s goal is about maintaining stable employment, an assessment of their overall treatment progress should target their recent work history, how well they are performing at their job, etc.
In addition, a multi-disciplinary approach to treatment and evaluation should be adopted. This may include psychological testing, interviews and other tools to assess a patient’s physical and psychological changes. It can also involve using different modalities, such as art, music or movement therapy, to help patients identify and express feelings or changes. Additionally, newer methods, such as using placebo controls and multi-method assessments, may also provide a more accurate picture of clinical progress.
By combining a personalized and multi-disciplinary approach, the clinician can better understand the impact of mental health treatments, ensure that changes are accurately tracked (i.e., monitored throughout the course of treatment), and interventions are tailored to meet individual patient needs. By doing so, mental health care can be more effective, efficient and personalized.
It is essential to be critical when evaluating research on mental health treatment progress. To continue progressing in mental health, we must invest in research to develop new measures that better assess clinical progress.
Max E. Guttman is a Licensed Clinical Social Worker, mental health therapist and disability rights advocate. He has worked in various systems of care in New York State, both as a clinician and as a peer. Max is also the editor-in-chief of Mental Health Affairs, a website for the mental health prosumer.
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