Editorial

Article Type: Editorial From: Mental Health Review Journal, Volume 17, Issue 1

Evidence-based practice has been in the lexicon of health and social care for many years. However, the successful implementation of interventions based on research evidence within routine clinical practice could be described as at best“patchy”. Cooksey (2006) and Tooke (2008) called this the second gap in translation or the crack between knowing and doing. The reasons why clinical decisions are not always based on the research evidence available are varied and span across organisational, professional and individual domains. The relevance of research to the specific circumstances individual practitioners work in and the pressures of providing frontline services may limit the desire to engage with it. However, in the current economic climate providing effective (including cost effective) treatments to service users to improve the quality of care they receive has never been more important. Similarly, being able to provide evidence of the value and worth of a service in either the statutory or third sector(voluntary and community services) is crucial to its ongoing commissioning and survival.

In this vein, this edition of Mental Health Review Journal addresses some of these issues at the complex interface of research and clinical practice. Three of the four papers included here discuss service evaluations conducted in both statutory and third sector organisations, direct attempts to generate and provide evidence to support the services they are providing. The first in this trio of papers by Palmer et al. present the results from an audit evaluation of a specialist independent mental health advocacy service in the UK. Using interviews with service users they identify that it was the proactive ethos as well as the formal advocacy provided which had a positive impact on service user engagement and outcomes. In particular self-reported wellbeing,self-efficacy and empowerment were all found to be increased for the service users involved. As the authors identify in their paper enhancing personal empowerment is a primary objective for advocacy and the positive wellbeing reported is an encouraging sign for their service.

The second paper by Thomas et al. focuses again on mental health care within the third sector of the UK. They report lessons from an evaluation of a pilot project, in three different geographical areas, for young people with mental health problems. Thomas et al. used a combination of observation, interview and group discussion with both service providers and users to build a picture of the factors which enabled the project to be implemented in the three sites. Their findings are interesting as although the project was perceived universally to be beneficial, there were differences in views as to whether it complemented or challenged statutory provision. The authors state that the ethos of the third sector may confront that of statutory services. The identification of this potential for conflict between different sectors is interesting. In countries such as the UK where substantial cuts to statutory provision are being made; third sector organisations are being looked towards to make up the shortfall. As Thomas et al. highlight this has the potential for the development of radical service innovations but also for possible cultural conflicts between providers.

It is to the statutory sector that we go to for the final paper in the three looking at service evaluation. Unlike the previous two, Kerfoot et al.explored the challenges of evaluating psychological input into acute mental health wards using traditional methods such as randomised controlled trials. However, they were able to provide an example of how it is possible to measure outcomes at multiple levels using self-report questionnaires. The “levels”included service users, staff and the wider organisation. They explored factors such as the impact on satisfaction, service utilisation and quality of therapeutic environment following the introduction of a dedicated psychology team. Positive trends were found in the service user experience of the ward environment and reductions in both readmission rates and length of stay in hospital.

The above trio of papers demonstrate the importance of producing evidence within the context of care to support what is currently being provided to service users. However, research generated elsewhere can also add to the evidence base clinical services draw on to support what they do and Mental Health Review Journal has an international focus. It is to Norway that we go for the final paper in this issue. Bonsaksen examined gender differences in relation to physical activity, psychiatric symptoms and quality of life for service users with severe mental illness who were admitted to hospital. They used a cross sectional design with a total of eighteen participants (12 men and six women). Although the study used a small sample some interesting insights were shown namely that women had lower levels of quality of life and tended to have more depression than men. More global psychiatric symptoms were found in the men in the sample. However, when depression was controlled for the relationship between being male and a higher quality of life was less robust. Bonsaksen suggest that the findings from their study indicate that women with severe mental health problems have higher levels of depression and lower quality of life than men. They argue that to improve the quality of life for women with severe mental illness it is important to identify and treat depression.

This has been a very interesting issue of Mental Health Review Journalto edit and it has been a pleasure to read about the innovative and diverse projects which are all aiming to improve the care given to people with mental health problems. I hope that through reading these four papers others are encouraged to write about their experiences and to continue to inform the ever growing evidence base for the provision of mental health services.