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End of the road for treatment-as-usual studies?

  • Tom Burns (a1)
Summary
Summary

Using treatment as usual (TAU) in trials has obscured the repeated finding that assertive outreach has never reduced hospitalisation when compared with treatment by multidisciplinary teams (community mental health teams, CMHTs). Its use has delayed recognising that CMHTs are the more cost-effective, evidence-based approach. The term should be abandoned and trials should compare two equally well-defined services.

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References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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End of the road for treatment-as-usual studies?

  • Tom Burns (a1)
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eLetters

Getting things in perspective

Julian D Eaton, Mental Health Advisor, W Africa
30 July 2009

In his reappraisal of treatment as usual (TAU) studies (1), ProfessorBurns states that ‘most of us can claim to be in clinical equipoise when we initiate a study’. This may be true in the United Kingdom, but in researching complex interventions in an African setting, we usually encounter quite another ‘curse of TAU’. When TAU means ‘no treatment’, itis difficult to ethically justify using as research subjects people who donot have access to treatment of any kind.

The British Journal of Psychiatry’s conscious efforts to support research in Low and Middle Income countries(2) is laudable, for example the partnership between International Psychiatry and The African Journal of Psychiatry. This would be further reinforced by instilling a mindset in contributors that includes consideration of practice in other international contexts, particularly when articles are discursive in nature. In fact, this article concludes by making the point that ‘background practice’ varies in different healthcare systems. International differences are not just incidentals, a way of showing the European situation in sharper focus. The overwhelming majority people with mental disorders live in poorer countries in the world. International psychiatric research has the potential to have a huge impacton their quality of life, and is becoming more focused towards this practical aim (3,4). The British Journal of Psychiatry would do well to embrace this new movement by ensuring a broader international perspective in its output, thus better reflecting the real global situation.

1. Burns T. End of the road for treatment as usual studies? Br J Psychiatry 2009; 195: 5-6

2. Tyrer P. From the Editor’s Desk. Br J Psychiatry 2004; 184:100

3. Chisholm D, Flisher AJ, Lund C, Patel V, Saxena S, Thornicroft G, Tomlinson M (Lancet Global Mental Health Group). Scale up services for mental disorders: a call for action. Lancet 2007; 370(9594):1241-52

4. The Movement for Global Mental Health, accessed at www.globalmentalhealth.org
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Conflict of interest: None Declared

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