What Is Mental Health Services Research?
Although mental health services research is not easily defined, it “consists mainly of those studies examining the effectiveness of the health care system in the prevention, diagnosis, and treatment of individuals with or at risk of mental disorders” (Kelleher and Long 1994, p. 133). Effectiveness should be defined broadly, allowing examination of issues such as service access, utilization, cost, and quality in addition to issues of service impact (ie, outcome evaluation) but deemphasizing specific disorders or conditions. The classic delineation of areas within services research distinguishes between clinical (or process) and systems (or structural) research. Clinical health services research is relatively more narrow in focus and includes, for example, investigation of the outcome of specific interventions and the relationship between clinicians and patients. Systems research is typically broader, encompassing organizational and financial factors that affect the delivery or quality of health care.
The National Institute of Mental Health (NIMH) (1990) identified five major areas of investigation in mental health services research: (1) Epidemiology focuses on the individual, family, and cultural characteristics of those seeking mental health services; (2) assessment emphasizes the best means of assessing disorders or functioning; (3) treatment examines the methods to assess effectiveness, treatment intensity and modality, setting, and specified target population; (4) rehabilitation and habilitation explores the methods of examining the effect of rehabilitation services for social skills, independent living, or vocational rehabilitation; and (5) outcome focuses on estimating the impact of mental health services on clinical symptoms, social and vocational functioning, family and patient well-being, and public welfare.
Mental health services delivered in naturalistic settings require not only effective psychiatric and medical treatment but also a variety of social, educational, vocational, and housing services. Many people have recognized the importance of interagency collaboration to plan and implement multifaceted treatment. In turn, mental health services research must be interdisciplinary in nature, drawing on individuals with backgrounds in psychology, psychiatry, epidemiology, statistics, biostatistics, economics, sociology, political science, and the law. Because of the necessity of interorganizational relationships and coordination for optimal functioning of the mental health system, mental health services research also must rely on research that focuses on the process of providing mental health services to patients and their families. It is necessary to understand the treatment process and interorganizational interactions to appropriately interpret any outcome that results.
Mental health services research is still in its infancy. Seemingly basic issues are still being examined. How much do systems of care cost? How can costs be controlled? Which models of care lead to the best outcome? How can quality be defined, assessed, and maintained? With the complexity of all the features that contribute to an integrated, coordinated mental health service system, and in light of system reform and managed care, multidisciplinary teams of researchers are best equipped to examine the process and effects in all the substantive areas (eg, economic, organizational, psychological).