Mental Health Services Research The provision of mental health services is a critical aspect of the overall healthcare system, addressing a wide range of needs related to mental disorders, which are among the leading causes of disability worldwide. This article explores mental health services research (MHSR), its interaction with other healthcare departments, the differences in interventions and services, and the dissemination of research outcomes, particularly in publications such as those from the American Psychiatric Nurses Association (APNA).
Mental Health Services Research
Definition and Importance of MHSR:
Mental Health Services Research (MHSR) is a specialized field within health services research that focuses on understanding the delivery, accessibility, cost, and quality of mental health care services. It aims to enhance mental health care within diverse health systems and sociopolitical and cultural contexts (National Institute of Mental Health [NIMH], 2003). The importance of MHSR has been increasingly recognized as mental disorders are now acknowledged as leading causes of disability both in the United States and globally (Office of the Surgeon General, 1999; World Health Organization, 2001).
Goals of MHSR:
MHSR generates new knowledge to transform mental health services, aiming to achieve high-quality, accessible, recovery-oriented care for all individuals (President’s New Freedom Commission on Mental Health, 2003). It applies methods from general health services research to a wide range of topics, including:
- Sociocultural Aspects: Examining how cultural, social, and political factors influence mental health care delivery.
- Access and Acceptance: Investigating barriers to accessing mental health services and factors influencing acceptance of care.
- Effectiveness of Usual Care: Evaluating the effectiveness of mental health care provided in typical or “usual care” settings.
- Economics and Financing: Studying the economic aspects and financing mechanisms of mental health services.
- Quality of Care: Assessing the quality of mental health care processes, adherence to treatment guidelines, and outcomes (NIMH).
Interaction with Other Health Care Departments
Interdisciplinary Nature of MHSR:
MHSR is inherently interdisciplinary, integrating expertise from various fields, including psychiatric-mental health nursing, psychology, psychiatry, social work, anthropology, sociology, economics, biostatistics, health administration, and public policy. This broad interdisciplinary approach is necessary because MHSR covers diverse research topics that require synthesizing literature from multiple fields, constructing complex research designs, developing data collection protocols, and employing sophisticated data analysis methods.
Collaboration Across Disciplines:
Collaboration is critical in MHSR, as the complexity of mental health issues often demands the integration of different perspectives and methodologies. For instance, researchers may work together to investigate the sociocultural factors affecting mental health care delivery, utilizing insights from anthropology and sociology, or they may collaborate with health economists to explore the financing and economic implications of mental health services.
Funding and Support:
Research funding for MHSR comes from multiple sources, including local, state, and federal agencies. At the federal level, the NIMH Division of Services and Intervention Research (DSIR) is a primary supporter. Most federally funded research centers for mental health services are led by non-nurse researchers, with some exceptions, such as the Southeastern Rural Mental Health Research Center (SRMHRC) at the University of Virginia School of Nursing. This center, funded by NIMH since 1992, focuses on unmet mental health needs in rural settings.
Difference in Interventions and Services
Interventions vs. Services Research:
Distinctions between interventions (treatment) and services research in MHSR can be somewhat vague (see NIMH’s Bridging Science and Service report, 1998b). However, nurse researchers have historically focused more on mental health interventions, specifically treatment efficacy and effectiveness, rather than on broader service systems research.
Nursing Focus on Interventions:
MHSR programs led by nurses are relatively rare, reflecting the limited number of nurses entering psychiatric nursing and the small number of nurses with doctoral and postdoctoral training in mental health services research (Delaney, Chisholm, Clement, & Merwin, 1999). Furthermore, few doctoral programs in nursing prepare students specifically for MHSR.
In 2001, recognizing the need to increase the number of mental health services researchers, the American Psychiatric Nurses Association (APNA) initiated a postdoctoral mental health mentorship program titled “Building the Capacity of Psychiatric Mental Health Nurse Researchers.” Co-sponsored by the National Institute of Nursing Research and the National Institute of Mental Health (Cochrane, 2001), this program included a technical workshop on grant writing, followed by mentorship to develop a full grant application.
Publishing Outcomes in APNA
Dissemination of Research Findings:
MHSR findings are disseminated through various academic journals that publish mental health services research, such as:
- Archives of Psychiatric Nursing
- Issues in Mental Health Nursing
- Journal of the American Psychiatric Nurses Association
- Journal of Psychosocial Nursing and Mental Health Services
- Mental Health Services Research
- Psychiatric Services
Other journals not specifically focused on mental health or health services research may also publish relevant studies. According to Pullen, Tuck, and Wallace (1999), mental health nursing research priorities include quality outcomes and delivery systems.
Merwin and Mauck (1995) noted that relatively few psychiatric nursing studies were published in major nursing journals, and there was a lack of programmatic research to support rigorous outcome evaluations. A review conducted for the Encyclopedia of Nursing Research a decade later showed that these earlier conclusions remained valid, indicating little change in the quantity or quality of published psychiatric nursing research.
Examples of Recent MHSR Publications:
Recent examples of MHSR appearing in nursing journals include:
- Baradell and Bordeaux (2001): Studied patient outcomes and satisfaction with psychiatric clinical nurse specialists.
- Merwin, Hinton, Dembling, and Stern (2003): Investigated the shortages of rural mental health professionals, highlighting significant gaps in mental health service provision in rural areas.
Interaction with Other Health Care Departments
MHSR’s interdisciplinary nature promotes collaboration with various healthcare departments. Key interactions include:
- Psychiatric-Mental Health Nursing: Nurses play a vital role in direct patient care, implementing mental health interventions, and contributing to research on patient outcomes and satisfaction.
- Psychology and Psychiatry: These fields provide insights into mental health assessment, diagnosis, and therapy development. Psychologists and psychiatrists work closely with mental health nurses to develop and evaluate effective treatment interventions.
- Social Work: Social workers often collaborate with mental health services to provide support, advocacy, and case management for patients, particularly in community-based settings.
- Anthropology and Sociology: These disciplines contribute to understanding the cultural and social determinants of mental health and illness, informing more culturally sensitive and socially appropriate interventions.
- Health Economics and Administration: Research in these areas informs the financing, organization, and delivery of mental health services, contributing to policy development and resource allocation.
The Future of Mental Health Services Research
Challenges and Opportunities:
Despite the progress made, several challenges remain in advancing MHSR:
- Limited Workforce: There is a shortage of doctoral-level nurses with specialized training in MHSR. Increasing the number of nurse researchers is crucial to enhancing the contributions of nursing to this growing field.
- Need for Programmatic Research: There is a continued need for more programmatic research that rigorously evaluates mental health services outcomes and identifies best practices.
- Funding and Support: Sustained funding from federal and state sources, as well as support from academic institutions, is essential for developing the capacity and infrastructure needed for high-quality MHSR.
Opportunities for Growth:
- Expanding Research Training: Expanding doctoral and postdoctoral training programs in MHSR, particularly those that focus on building capacity among nurse researchers, will help address workforce shortages.
- Interdisciplinary Collaboration: Strengthening interdisciplinary collaboration will enhance the scope and impact of MHSR, facilitating more comprehensive approaches to mental health care.
- Leveraging Technology: Utilizing digital health tools and telehealth can improve access to mental health services, especially in underserved areas, and provide new avenues for research.
Conclusion
Mental Health Services Research is a vital and evolving field that seeks to improve the delivery, accessibility, and quality of mental health care. Its interdisciplinary nature necessitates collaboration across various healthcare departments and disciplines. Despite challenges such as a limited workforce and funding constraints, there are significant opportunities for growth through expanded training, interdisciplinary collaboration, and technological innovation. By addressing these challenges and leveraging these opportunities, MHSR can continue to contribute to the transformation of mental health services and improve outcomes for individuals with mental health needs.