On the need for randomised trials of therapeutic community approaches

Evidence-based practice is repeatedly emphasised in mental health care. However, a number of objections have been raised in response to calls to carry out randomised controlled trials (RCTs) in therapeutic community (TC) settings. In the context of an increasing emphasis on particular kinds of evidence to demonstrate the usefulness of health care interventions, a meeting of experts was convened in Oxford, UK, in 2008 to examine the question of whether such studies were desirable and possible. Taking these discussions as its starting point, this paper examines the objections to carrying out a randomised trial of TC treatment, and describes how a randomised controlled trial of health TCs for personality disorder currently underway in Oxford has addressed them. The Oxfordshire Complex Needs Service is an intensive treatment service for people suffering from personality disorders and similar conditions. The paper presents details of how the RCT was developed, and demonstrates that it is possible to address the major concerns in the design of RCTs.

Publication year:2010