Not Only Clinical Efficacy in Psychological Treatments: Clinical Psychology Must Promote Cost-Benefit, Cost-Effectiveness, and Cost-Utility Analysis

Treating mental disorders is a critical issue for modern societies due to high costs for the different national healthcare systems.Evidence-based psychological therapies and structured psychotherapies have been recommended for common mental health problems, but real provision of them has not yet achieved significant spread and impact (Mukuria et al., 2013).To improve access to psychological therapies may provide cost-effective solutions, since their positive long-term impact on health has been largely demonstrated (Castelnuovo, 2010a,b;Campbell et al., 2013;Dezetter et al., 2013;Mukuria et al., 2013;Emmelkamp et al., 2014).However, in many developed countries, such as France or Italy, psychotherapies are not enough covered and promoted by the national healthcare systems and health insurance companies (Dezetter et al., 2013).Differently, in the UK, to tackle the huge problem of mental illness, a comprehensive programme of psychological therapy has been launched and watched worldwide.An estimation of its long-term clinical and economic benefits, has, in fact, led to ascertain that "psychological therapy costs nothing" (Layard and Clark, 2014;Clark and Layard, 2015).In order to mimic the positive experience developed in the UK, other countries have now to demonstrate not only the fundamental role and scientific validity of psychological treatments in both clinical and health settings, but also their significant cost-efficacy.As noted by Emmelkamp et al. ( 2014), "There is little doubt from a scientific perspective that psychotherapy according to this definition is effective, highly beneficial and cost-effective for a wide range of mental disorders and health conditions, such as anxiety, stress and trauma-related disorders, depressive and somatoform and pain disorders, personality disorder, substance use disorders and behavioral addictions, eating disorders and a number of childhood disorders.For all these disorders, various variants of CBT have been established in clinical randomized trials" (pp.66, 67), but research in psychotherapy lacks of cost-benefit analysis of interventions: "even if a psychological treatment could show strong efficacy and/or effectiveness, due to high costs it might never be assimilated in real clinical practice " (p.67, Emmelkamp et al., 2014).Unfortunately, most clinical psychologists and psychotherapists are not willing to measure the impact of their clinical practice, even if Beutler (2009) underlined that the gap existing between science and practice could be more imputed to scientists' attitude than to practitioners' intransigence: "scientists were intentionally obscuring many important results because of an unwarranted devotion to a limited number of scientific methods.