Current Medical Diagnosis & Treatment in Psychiatry

Functions of Mental Health Services Research

The ultimate goal of mental health services research is to influence policy and programmatic decision-making in order to improve mental health services. The evaluation of programs, services, and systems provides a relatively objective means of choosing among alternative programs or services competing for limited resources and informing decisions that will affect public policy. Services research may provide information about the services that are being delivered as compared to those intended, how services are being utilized and by whom, the extent to which services are effective, and the costs of services. In addition, evaluation encourages accountability, cost-consciousness, and responsiveness to those in need of and utilizing services. Further, services research can synthesize what is already known, unearth false assumptions, debunk myths, develop new information, and explain the implications of this information for future decision-making. Moreover, it may be unethical to continue to provide untested, perhaps invalid, services to children and their families in the name of treatment.

In order to make such an impact, it is necessary to build a knowledge base about what is currently known in the field. It is then possible to identify and focus on the gaps in the existing research. To overcome some of the limitations of existing research, multidisciplinary research using multiple methods and innovative methodologies and analytic strategies have been used. For instance, drawing on the perspectives of all stakeholders in the process of evaluation increases the relevance of research findings for practice in the field. Further, analytic strategies such as meta-analysis have been used to synthesize the existing research.

The link between clinical practice and services research must be captured to provide balance in the representation of the variety of stakeholders in the professional community. Clinicians and services researchers jointly can examine patient selection processes; effectiveness of complex interventions; and the effect of financial and organizational factors on selection of treatment settings, choice of treatment, intensity of care, and the provider mix.

In addition to enhancing clinical practice, mental health services research also can inform public policy. With the proliferation of managed care in the health services, services research that examines the impact of managed care on service delivery and the associated outcome will help to guide public policy. The mental health services system is constrained by external stakeholders such as health insurance companies, entitlement programs, and social welfare legislation. Mental health services research informs public policy by examining the effect of these external constraints on the individual-, service-, system-level outcome.

Finally, one of the major functions of mental health services research is disseminating the findings and informing the community as a whole. In order to make services research as useful as possible, researchers must carefully report evaluation results, even though potentially unpopular, and thoroughly note the constraints and limitations of any study as well as the generalizability of the findings. Chelimsky (1995) emphasized two types of credibility, relating both to substance and to presentation, that are necessary for effective dissemination. Three critical means of enhancing substantive credibility include conducting a thorough literature review, critiquing the methodology, and anticipating potential attacks on the evaluation findings. Regarding credibility of presentation, Chelimsky suggested that even an ideal study can be misrepresented if it is presented in a careless fashion. Finally, services research findings must be communicated appropriately to a diverse audience including patients and their families, policy makers, clinicians, funding agencies, insurers, and the public at large.

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