Is treatment helping? How providers gauge effectiveness in treating serious mental illness

This study aims to determine providers' perspectives on what effective therapy for serious mental illness (SMI) consists in and how to assess and achieve it. We gathered semi-structured interviews of 26 psychologists, psychiatrists, and clinical social workers in varied practice settings in a Midwest state (US) in April–June 2018. Each participants provided at least 10 ​h of care per week to clients experiencing SMI. We also obtained demographic and practice-type data by questionnaire. Using deductive coding, we found that participants' intervention goals vary widely and depend on client input; goals change over time and circumstance. Participants often use standardized measures to assess progress, but they rely primarily on global assessment of well-being and change. Building relationship is key to achieving goals; changing intervention type as needed is also important. Effectiveness also depends on clients’ willingness to change. The most consistently noted barriers to effectiveness were systemic, such as lack of access to social goods. While expressing confidence in their own practices, participants noted gaps in the knowledge base. Thus, participants indicated four common factors relevant to effective therapeutic intervention: The positive roles of client-provider relationship and the providers themselves, the negative role of systemic barriers to intervention, and the bivalent role of client engagement. Each factor is expressed in highly variable and individualized ways across interventions, and to a lesser extent across professions. In addition, many participant comments did not fit the deductive framework implicit in our questions and coding, as the participants described exploratory, reactive processes of therapy rather than linear ones. Together, the high variability and non-linearity suggest a mismatch between therapeutic practice and many research methodologies. More broadly, the absence of a shared understanding of effectiveness of SMI intervention suggests a barrier to improving clinical, research, and social aspects of care for individuals who experience SMI.