Mar 23, 2022·edited Mar 23, 2022

Great update, thank you.

This aspect of it seems especially high leverage:

> They fund treatments that are ‘cost-effective’, which often means ‘cost-legible’, and ‘evidence-based’, which often means ‘has had the support of research for long enough to have a lot of fairly robust studies that show positive things’.

I’m especially curious about what fuels your strong conviction that these alternative options are net-better for patients. My intuition matches yours, but I wonder if there are any objective “legible” metrics to be found to convince the institutional funders?

You started this post with:

> People who advocate for peer respites and soterias consider them more humane alternatives to psych wards, which lock people inside and treat them primarily with medication, in a way that often feels alienating and dehumanizing.

Which feels like a good start. Is there any clear data on differences in outcomes?

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There's a whole other post in answering this question, I think (at least). The TLDR is that all kinds of treatments, particularly psychosocial ones, get great results in initial studies, and then as the studies are scaled the outcome data starts to look more and more like all the other treatments (i.e. not great). My hunch is there's something here that is immeasurable using current experimental methods, something like 'how much the people around you care about your situation and have the ability to respond to it' which explains why -any- new treatment (developed by motivated, compassionate clinicians) is going to show better results than a treatment delivered by a burnt out pre-licensure therapist who has a caseload of 50 clients and is paid basically minimum wage. This is something I've run into again and again and which is a problem for any new 'treatment'. I think there's something here that is messed up about the definition of a treatment, but it's something I'm still not clear on.

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I wrote something that addressed part of this question here: https://psychcrisis.substack.com/p/the-relational-reimbursement-paradox?s=w

(Specifically the bit I call the social research scaling problem).

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