What is the most effective way to treat mental health?
It’s a simple question, and with the millions and millions pouring into mental health globally today (£580m in 2019 alone, pre-pandemic) and the enormous cost to society of mental health problems (estimated at $16 trillion annually by 2030), surely we are directing that capital wisely to what are the most effective, evidence-based interventions to address what is a crippling crisis?
We are lucky that there is now so much support and guidance available from charities, governments and private corporations on how to best manage our mental health, from managing it on a daily basis to times of acute distress.
Interventions include everything from the cool and current, celeb-endorsed mindfulness and meditation apps like Calm and Headspace to the old school, time-tested treatments of professional talking therapies. In addition to these, there are a plethora of other options, from peer support, regular exercise, CBT, IPT, sleeping hygiene, counselling, micro-dosing, anti-depressants, art therapies or other alternative therapies.
With so many options available, there must be concrete academic studies that have compared each intervention so we can which is going to be the most effective (and subsequently the most cost-effective), right?
As it stands, there do not appear to be (if you do know of any please direct me to them) any definitive or even vaguely authoritative studies that have compared all major mental health interventions against one another in a Random Controlled Trial (‘RCT’) over a reasonable period of time in a double-blind experiment.
There may be occasional meta-analyses or systematic reviews comparing a few of these treatments or interventions to one another but they are by no means conclusive or extensive and unlikely to answer the question of “which is the most effective intervention?” or more pertinently, “which is the most effective intervention for me?”.
To be clear, I am not saying the current interventions are not effective or that research hasn’t already proved this, I am saying we need some way of comparing and ranking them, and identifying which work best in each situation, e.g. ‘meditation improves wellbeing of 18–24 year old females with low level mental health problems by 15%’ so we can better direct and triage those experiencing such problems.
I appreciate this is not a small or simple study to carry out, and that there will be significant hurdles to overcome in conducting it, but that is absolutely no reason not to work through them.
Yes, it is difficult to measure the status of someone’s mental health at a point in time, there (currently) are no truly definitive physiological objective measures, but we do have several (albeit survey-based) measures that are used widely (and there is no reason we could not use all of them in such a study) and largely recognised by bodies of psychologists and psychiatrists to be relatively good proxies, such as the PHQ-9 or the WHO-5.
Yes, interventions may work differently for different people, depending on age, demographic, extroversion etc, but that just means we need more people in the study and to record and control for such data.
Yes, it will be hard to ensure that patients do not combine interventions, e.g. how do you ensure someone undergoing CBT isn’t also using a meditation app or getting peer support from their friends? But this can be logged and taken into consideration in the analysis.
And yes, it will take a long time to carry out such a study as we would probably need to observe over at least one year, if not several, and we will need a lot of people involved to ensure the results are statistically valid but that just means we should start sooner rather than later.
With so much investment pouring into the mental health space and such an urgent demand we have an obligation to ensure it is directed to the most effective interventions so we can be sure money isn’t wasted and it helps the most people.
This should be the #1 question we are asking in mental health now, so let’s find an answer.