Tanenbaum Sandra
School of Public Health, Ohio State University, Columbus, OH 43210-1234, USA.
J Eval Clin Pract. 2003 May;9(2):287-301. doi: 10.1046/j.1365-2753.2003.00409.x.
RATIONALE, AIMS, AND OBJECTIVES: Evidence-based medicine (EBM) has given rise to evidence-based practice (EBP) in the field of mental health. EBP too is predicated on an evidence hierarchy and has the goal of using the "best evidence" (usually randomized controlled trials) to improve practice. EBP is increasingly influential in mental health care in the U.S. Growing numbers of researchers and public officials endorse its claims and pursue its benefits. The rationale for this paper is to examine the potential of EBP for the field of mental health-and public mental health care specifically. Is it likely to contribute to improved lives for mentally ill people? If so, how?
This qualitative study relies on archival, and to a much lesser extent, informant interview data. Informants were mostly public mental health officials because they are in a position to implement EBP on a large scale and their policies are a matter of public record. Interviews were semi-structured, held in person and on the telephone, and lasted one to two hours. Archival research included the substantial literature on EBM and EBP plus studies and articles on the practice and policy of U.S. public mental health care.
The results of this study were that there exists an extensive, coherent literature critical of EBM and of EBP specifically. Attempts to implement EBP will falter on epistemological and organizational barriers. Still, as a public idea--that more science will bring about better mental health practice--EBP may well serve political purposes, especially in the U.S. public mental health system, where more overtly ideological policies have been inadequate in the past. EBP, as a public idea, has the advantage of ambiguity, accountability, quantifiability, etc.
This paper concludes that EBP is growing more influential in public mental health care in the U.S. Its practical strengths, i.e., its improvement of mental health practice, may turn out to be less than its strengths as a public idea in the formulation and dissemination of mental health policy.
基本原理、目的和目标：循证医学（EBM）在心理健康领域催生了循证实践（EBP）。EBP同样基于证据等级体系，目标是运用“最佳证据”（通常为随机对照试验）来改进实践。EBP在美国的心理健康护理领域影响力日益增大。越来越多的研究人员和政府官员认可其主张并追求其带来的益处。本文的基本原理是审视EBP在心理健康领域——尤其是公共心理健康护理方面的潜力。它是否有可能改善精神病患者的生活？如果是，如何改善？
这项定性研究依赖档案资料，在较小程度上还依赖 informant 访谈数据。 informant 大多是公共心理健康官员，因为他们有能力大规模实施EBP，且其政策属于公开记录事项。访谈采用半结构化，通过面对面和电话方式进行，持续一到两小时。档案研究包括大量关于EBM和EBP的文献，以及关于美国公共心理健康护理实践和政策的研究与文章。
本研究结果表明，存在大量连贯的文献对EBM尤其是EBP提出批评。实施EBP的尝试将在认识论和组织方面的障碍上受阻。不过，作为一种公共理念——更多的科学将带来更好的心理健康实践——EBP很可能服务于政治目的，特别是在美国公共心理健康系统中，过去更为明显的意识形态政策并不充分。作为一种公共理念，EBP具有模糊性、可问责性、可量化性等优势。
本文得出结论，EBP在美国公共心理健康护理领域的影响力日益增强。其实际优势，即对心理健康实践的改善，可能不如其作为一种公共理念在心理健康政策制定和传播方面的优势。
