© 2008 The Royal College of Psychiatrists
Book reviews |
Choosing Methods in Mental Health Research
North East Public Health Observatory, Wolfson Research Institute, University Boulevard, Stockton-on-Tees TS17 6BH, UK. Email: gyles.glover{at}gmail.com
Edited by Mike Slade & Stefan Priebe. Routledge. 2007. 298pp. £29.95 (hb). ISBN 9781583918449
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Advocates of `evidence-based policy' assert that `what matters is what works'. This perspective became fashionable in England after the 1997 general election. Mental health service researchers like to see themselves as contributing to the fund of `evidence' which should rightfully determine policy. The problem is whether others agree. Solesbury1 identifies a number of key questions. Is there consensus about what the questions are and how they should be formulated? What sorts of evidence are persuasive to the types of people influencing care provision? How far can conclusions be generalised? And does the public still trust professionals to give the `right' answers as opposed to self-interested ones? Slade & Priebe set out to open up this debate, providing us with a symposium-in-a-book.
Sections cover research methods and the factors that appear to influence practice in different clinical areas and different countries. Four final chapters reflect on what gives research impact. Read these and the introduction first, since they set out the ground for the debate.
Beresford, giving a service-user perspective, argues for explicitly value-based research. His interest is in research that empowers and improves the lives of service users by its design as well as its questions. Bracken & Thomas explore how research benefits funders and researchers while entrenching service users' states of disadvantage.
Reading the earlier chapters on methods, the question becomes how the contributors have located their offerings in this context. Some tell us, some just set out their stall and, tellingly, a few seem to have missed the point altogether.
The chapters describing what actually appears to influence practice are sobering. Walters & Tylee identify a range of policy exhortations and educational initiatives for general practitioners. While explicitly upbeat about these, they note that mental health issues have only a small effect on bonus payments. Their implication seems to be that these are the `evidence' general practitioners understand.
Burns writes cogently about community mental health team practice, providing a nice analysis of the features of the famous Madison study2 which enabled it to be so influential; however, the study he describes as having most impact on practice in England is the report on the care of Christopher Clunis. Curiously, despite its painstaking attention to evidence, he classifies this as `non-academic'.
Holloway notes the wide range of influences people regard as evidential and the tendency of recent government publications to be couched in evidence-based language while apparently lacking the peer-scrutiny normally associated.
Perspectives from other countries provide evidence of the need for scandals as a spur to reform and the tendency of de-institutionalisation to transfer care resources from the more to the less needy.
Where do the authors stand? They emphasise that their book is not about research ethics but about the concept of evidence. If research funders want to back work that will influence policy-makers and practitioners, those writing research proposals should consider what impresses these audiences and not confine their attention to the referees of mental health journals.
REFERENCES
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1
- Solesbury W. Evidence-Based Policy: Whence it Came and Where it's Going. ESRC UK Centre for Evidence-Based Policy and Practice. Queen Mary University of London, 2001. http://www.evidencenetwork.co.uk/Documents/wp1.pdf 2
- Stein LI, Test MA. Alternative to mental hospital treatment. I.
Conceptual model, treatment program, and clinical evaluation. Arch
Gen Psychiatry 1980;
37: 392-7.
[Abstract/Free Full Text]
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