Is ‘minimally adequate treatment’ really adequate? investigating the effect of mental health treatment on quality of life for children with mental health problems

• Published in: Journal of affective disorders 2020-11, Vol.276, p.327-334
• Main Authors: Ride, Jemimah, Huang, Li, Mulraney, Melissa, Hiscock, Harriet, Coghill, David, Sawyer, Michael, Sciberras, Emma, Dalziel, Kim
• Format: Article
• Language: English
• Subjects: Adolescent; Australia; Child; Child psychiatry; Delivery of healthcare; Humans; Longitudinal Studies; Mental Disorders - therapy; Mental Health; Minimally adequate treatment; Outcomes of care; Quality of Life; Regression analysis
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2020.07.086

•Despite rising investment in mental health treatment, prevalence of mental health problems has not fallen. One explanation is inadequate treatment for those receiving care.•The concept of minimally adequate treatment (MAT) – which is defined based on clinical practice guidelines – sets the standards of expected care for children with mental health problems. These standards are used to determine whether the mental health care system is meeting the needs of the population and to identify who is missing out on adequate care.•This paper demonstrates that MAT may be an insufficient measure of treatment adequacy, and indicates the need for more rigorous measurement of the nature and outcomes of care in routine practice. Minimally adequate treatment (MAT) is intended to represent treatment minimally sufficient for common mental health problems. For children, MAT has been defined over a twelve-month period as either eight or more mental health visits, or four to seven visits plus relevant medication. MAT is used to identify those missing out on adequate care, but it is unknown whether MAT improves children's outcomes. This paper examines whether MAT is associated with improved outcomes for children. It uses survey data from the nationally representative Longitudinal Study of Australian children on 596 children with mental health problems based on the Strengths and Difficulties Questionnaire at ages 8–15 years, linked to health service administrative data from 2012 to 2016. Statistical analysis examines the association of MAT with later quality of life (Pediatric Quality of Life Inventory), using a lagged dependent variable model to account for time-varying unobserved confounding. Compared to children with lower levels of treatment, those who received MAT between baseline and follow up had no statistically significant improvement in either quality of life or mental health symptoms. The observational data provide insight into real-world practice but require statistical methods to account for selection into treatment. While clinical trials show mental health treatments can be efficacious, this study shows no evidence that children receiving MAT in routine practice have better outcomes. These findings demonstrate the need for better understanding of the nature and impact of children's mental health care as it is delivered and received in routine practice.