Guidelines for treating mental illness: love them, hate them. Can the SIEP-DIRECT'S Project serve in the search for a happy medium?

This paper discusses some key aspects of the debate on the difficulties of incorporating scientific evidence into the daily work of clinicians in mental health services (MHS). It highlights the topics of: the utility of guidelines in this field, the ethical principles that should guide their utilisation, their limitations, obstacles impeding the diffusion of guidelines in psychiatry, and strategies that can be useful for overcoming the barriers to guideline implementation. The SIEP-DIRECT'S ((DIscrepancy between Routine practice and Evidence in psychiatric Community Treatments on Schizophrenia) Project's potential role in fostering this advancement is discussed in detail. This Project developed a set of 103 indicators that operationalised the NICE clinical guidelines for schizophrenia recommendations and tested them in 19 MHS in Italy. A multi-step design was used to assess recommendation and indicator acceptability in the Italian context; provide an assessment of any current discrepancies between routine practice and guideline recommendations in the treatment of schizophrenia; and understand the reasons for any discrepancies that might emerge. This process, moreover, was instrumental in keeping the debate arising during conduction of this Project far from the excesses of hostility - and excesses of "bright-eyed enthusiasm" - that frequently influence discussion on topic. This Project therefore showed potential to serve in the search for a happy medium, that can facilitate the pursuit of a fundamental advancement in guideline implementation in mental health services.