April 2009
Therapeutic Interventions & Information
Mental Health Information can sometimes seem a dry subject. Partly this is because it seems to be focused so much on collecting information and not on actually using it. Using information is where it’s at - and that is anything but dry and uninteresting.
Therapeutic interventions from a mental health service perspective are most certainly where things are at. Therapeutic interventions are fundamentally what mental health services are about. Yet from an information perspective we don’t routinely collect information about particular types of therapeutic interventions (for example, the types of assessments, and the kind of psychological, pharmacological, social and emergency interventions being made by services).
In other words, from an information perspective we simply don’t know what interventions are happening within our mental health services (this is not exactly true since we do collect data on Team types which often reflect the kind of interventions they will make but this involves making assumptions about the type of interventions such teams are making).
This lack of information about therapeutic interventions is problematic for three main reasons:
- Firstly, if we want our clinicians and service users to be interested in mental health information then we need to provide information which they will find interesting and useful. As I mentioned in a previous column primary mental health information use should ideally be a driver for the way information is collected and used but -in large part because of the type of information which we are collecting- the focus is upon secondary uses of information.
- Secondly, if we don’t routinely collect information about what therapeutic interventions are happening then we will have no way of knowing which interventions are producing the best practical outcomes for service users. All the good work services are doing collecting HoNOS will be limited if we are unable to map outcome scores to particular therapeutic interventions. This will not overcome the problem of attribution (subject of a previous column) but it will make it easier to talk about what HoNOS scores might be indicating about particular interventions.
- Thirdly if we don’t have a way of attributing mental health outcomes in some way to particular types of intervention, then the possibility of benchmarking against interventions becomes difficult if not impossible. This is a significant issue since without the ability to judge the performance of services based on their fundamental activity (i.e. therapeutic interventions) such benchmarking will be of limited utility.
These are all good reasons for collecting therapeutic intervention information, but the main arguments against collecting such information appear to be definitional and practical rather than conceptual. These definitional and practical problems seem to centre on two questions.
- What is a therapeutic intervention? (the definitional question), and
- How can we capture therapeutic interventions in our information systems? (the practical question).
Therapeutic interventions are interventions made with the express intention of assisting mental health service users with their problems. Generally these are interventions made by mental health professionals, though not always. However in terms of capturing therapeutic interventions in our information systems, it is the interventions by professionals which are most easily captured. In making this assumption we are explicitly deciding not to be comprehensive in our approach to capturing therapeutic interventions, based on the need to be pragmatic.
This raises another question, which is related to the definitional one. How comprehensive can we be (or should we be) with the capturing of therapeutic intervention information? Clearly there is a level of comprehensiveness which it would be impractical to capture, in that it will involve clinicians spending too long filling in details of their intervention codes.
If we can’t be comprehensive with regards capturing therapeutic interventions how do we decide what to exclude? Some jurisdictions in looking at this issue, for example Australia, have decided to adopt a generic approach based only on ‘significant therapeutic’ interventions. This will have the advantage of allowing all professionals to fill out and use the same codes. However, the disadvantage is that ‘significant intervention’ is equated with structured session based work, which therefore misses the more informal approach which is so much part of good mental health care.
As a way of ensuring that we don’t miss that informal perspective for therapeutic interventions, and as a way of ensuring decisions on what to leave out are made by professional groups rather than administrators or analysts, I want to suggest the following principles for a mental health classification approach to therapeutic interventions:
- Adopting Generic codes, based on defined ‘important interventions’, for most of the therapeutic interventions covered in mental health services (in areas such as psychological, pharmacological, social and emergency care)
- Adoption of specific professional codes for professional groups (psychiatry, psychology, nursing, O.T and Social Work) which could be used to capture the more informal and casual therapeutic interventions of those professional groups.
- Adoption of specific cultural therapeutic intervention codes
- By ensuring the simplicity of use of the classification system
- By ensuring the system is logical
- By ensuring the classification system is expandable should new interventions come along
Currently PRIMHD is not capturing therapeutic interventions but the review of PRIMHD should seriously consider building in such a therapeutic intervention classification. At the very least a high level working group drawn from the sector with wide expertise needs to start meeting during the next year to agree a way forward. As I have already mentioned, this is not just about yet more information but the very heartbeat of mental health information. It’s time to take the information pulse of monitoring therapeutic interventions in our services very seriously.
Page last updated: 30 March 2009