Knowledge for Use
My research at LSE is part of a progressive inter-disciplinary project led by Nancy Cartwright looking at how evidence can be used to make better predictions for outcomes (Cartwright, 2013). Myself and Professor Cartwright, with Katherine Furman, are working on specific problems for policy makers looking to help people with depression back to work: how to intervene most usefully in a complex human social situation? Evaluation methodologies that privilege only RCT-derived interventions have tended to miss outcomes that matter to these clients and have also undervalued the proper place for complex, objective clinical judgment.
Alongside this research I am a practising psychotherapist, working in the NHS, providing evidence based psychoanalytic therapy; and training and supervising other clinicians in this new approach. In 2009 I was awarded a Fellowship by the British Association for Counselling and Psychotherapy for my contribution to developing evidence based practice; in 2012 I was awarded a CBE for my contribution to mental health as national adviser to successive recent governments in scaling up access to therapy on the NHS. Currently I am an advisor to NICE’s Centre for Guidance and a member of the expert group revising its Depression guideline. Since 2007 I have organised an annual conference devoted to scientific debates in evidence-based practice: Psychological Therapies in the NHS (see www.newsavoypartnership.org ).
The starting point for my collaboration with colleagues at LSE and Durham on Knowledge for Use is a question that has taxed governments across the developed world: if, as Beveridge (1942) proposed, the proper object of government is “the happiness of the common man”, then why have successive welfare regimes failed to deliver this? Together with Lord Richard Layard and David Clark (2014) the answer that we put forward in 2007 was their consistent blindness to the causal role of mental illness, as backdrop to a business case for improving access to evidence-based psychological therapies via the NHS. In 2012-13, however, when I led the 2nd National Audit of NHS therapy services for depression, the data that emerged showed a picture of continued variation in outcomes suggesting our original policy analysis was flawed. Whilst access to CBT had been increased uniformly the burden of depression had also increased and, according to a recent report (OECD, 2014), the UK has the highest rate of new claims for invalidity benefit (ESA due to depression) across the OECD countries.
In Knowledge for Use we have set ourselves a different question, therefore, which we think will offer a more useful way forward: how can practitioners who are working with people facing adverse personal, social and psychological circumstances understand the causal role of complex change mechanisms to secure specific wellbeing/work outcomes for their clients? We hope to discover better models for using professional judgement to predict what will work for whom, and better methods for NICE and the EU for future guidelines.
Beveridge (1942) Social Insurance and Allied Services; Report by Sir William Beveridge HMSO
Cartwright N. (2013) Evidence for Policy and Wheresoever Rigor is a Must ISSN: 2045-5577 London: LSE
Layard, R. & Clark, D.M. (2014) Thrive: the power of evidence-based psychological therapies London: Allen Lane
OECD (2014) Mental Health and Work in the UK Paris: OECD Publishing
Clarke, J.C. & Barkham, M. (2009) Evidence de rigueur: the shape of evidence in psychological therapies and the modern practitioner as teleo-analyst Clinical Psychology Forum, 2009, 202, 7-10
Clarke, J.C. (2012) The Blind Guideline-Maker: why NICE keeps missing what matters The Psychotherapist 51, Summer
Williams, R. et al (2016) Patient preference in psychological treatment and associations with self-reported outcome: national cross-sectional survey in England and Wales BMC Psychiatry, 16(4), 1-8
Presentations & Workshops:
(02.07.13) Auditing a Revolution: Results of the 2nd National Audit of Psychological Therapies for Depression International Congress of the Royal College of Psychiatrists, Edinburgh International Conference Centre, Edinburgh
(26.02.14) Educating Northerners: the challenge for the psychological professions improving wellbeing in the North West Psychological Professions Network Launch, Bolton Reebok Stadium
(09.10.14) With Nancy Cartwright: The Shock of the Real: mental health and employment interventions that will work here, now and for this client – improving wellbeing in Greater Manchester Centre for Humanities Engaging Science and Society and Institute for Advanced Studies, Durham University
(13.11.14) Vocational Activation: Improving wellbeing through ‘evidence-best’ practice Annual meeting of the Division of Clinical Psychologists, North West, Bolton Holiday Inn
(11.04.15) Improving wellbeing in Italy: some lessons from the UK experience Ufficio Ragioneria degli Psicologi del Piemonte, Annual Conference, Torino, Italy
(27.04.16) With Robert Elliott: What evidence works best for which NICE therapy? (Or why what works in research settings may not work in the real world) Centre for Humanities Engaging Science and Society and Institute for Advanced Studies, Durham University
(03.06.16) With Robert Elliott: Now its personal! How can we know when personalised support to help people get back to work is likely to be able to work? Centre for Humanities Engaging Science and Society and Institute for Advanced Studies, Durham University
(24.06.16) Re-setting the balance: from stepped care to matched or personalised care for common mental illness (Or it may have worked in California but will it work in Blackpool?) IAPT Northern Practitioners Research Network, Manchester University
(30.06.16) With Amra Rao Re-setting the balance: improving staff wellbeing in psychological therapies through more sustainable methods of quality improvement IAPTus Users Network Annual Conference, Tech UK, London