ABSTRACT
This chapter describes the types and applications of research that are relevant to mental health services, it includes, in the widest sense, evaluations designed to create evidence about which treatments and services do and do not offer benefits to patients. The term ‘evaluation’ is both widely and imprecisely used. This is especially the case when evaluation is applied to health services rather than to specific treatments. Our first task in discussing the evaluation of mental health services is therefore to define terms. In this chapter we shall proceed to consider why mental health services should be evaluated, especially because the clarification about the purpose of a particular evaluation is likely to bring into sharper focus subsequent decisions about research design. We shall next respond to the question of what needs to be evaluated, at the different levels of the mental health service, to produce information relevant for planners as well as for practitioners and patients. We shall go on to discuss how to evaluate mental health services, both in terms of the scales and instruments that may be useful, and the research designs the are available. In particular, we shall illustrate the range of designs with examples from one key domain of recent outstanding mental health research, namely the evidence about assertive community-based care for those with severe mental illness. In conclusion we shall discuss the key challenges of mental health service evaluation and their implications for future research and clinical practice.
Evaluation at its best is a systematic way of learning from experience and using the lessons learned to improve both current and future action. At its worst it is an activity used to justify the selection of a scapegoat for past failures.
(Sartorius 1983, pp. 59–67)