A call for more evidence-based practice

Our theme this month concerns the burgeoning call for the provision of evidence-based practice (EBP) in low- and middle-income countries (LMIC). It is worth remembering that EBP is not universally accepted by the psychiatric profession. For instance, there is still controversy about the relevance of randomised controlled trials in evaluating some forms of psychological treatment (Lilienfeld et al, 2018). Despite special pleading from some quarters that ineffective treatments can be justified because they work for selected patients, Lilienfeld et al draw attention to the inglorious and lengthy history of psychiatric interventions that were subsequently proved to be useless or even harmful.

An introductory review article by Tyler and Kyriakopoulos considers the barriers to promoting EBP across the world. They point out the excellent work done by the World Health Organization in providing updated intervention guides for mental and substance misuse disorders in LMIC. In our second paper, Caneo and Calderon consider the emergence of EBP in Chile where, in recent years, there has been an increasing rapprochement between clinical psychologists and psychiatrists and their respective roles in the management of mental disorders (Moncada, 2008). Chile introduced a set of national guidelines for the detection and treatment of depression in 2004, followed by further guidelines for schizophrenia, bipolar disorder and alcohol and substance misuse, and these have been updated every few years. Nevertheless, the authors take the view that the concept of ‘evidence’ in Chile is still not understood by clinical professionals in any consistent way; the doctor–patient relationship is often considered more important than EBP.

In our third contribution to this theme, Samartzis et al consider the way in which substance misuse disorders are addressed in Cyprus. This is a relatively wealthy country but one which spends little on state aid for medical treatments. Opioid addiction and cannabis use are more prominent than cocaine and stimulant misuse, both of which have decreased in prevalence over the past decade. There is a move to provide a variety of evidence-based treatments for alcohol addiction as well as a publicly funded programme to support smoking cessation. Nevertheless, effectively treating addiction in the context of the Cypriot mental health system remains a challenge.