Abstract
Whether you are a clinician, administrator, policymaker, or trainee, you likely find yourself asking questions about the quality, cost, reach, and value of your services. Mental health services research is a means of asking and answering vital questions like these—questions about service delivery at the policy, system, clinic, provider, and consumer levels. This chapter will introduce the reader to the core features of mental health services research that are salient to the needs of community psychiatrists. Beginning with an overview of health services research, we then highlight the significant gap between research supporting a new practice and the widespread uptake of that practice and discuss how health services research is evolving to close that gap. We use examples of highly impactful studies to guide the reader through a range of mental health services research approaches and topics. Finally, we introduce the rapidly growing field of informatics, connecting it to the work of community psychiatrists. We approach this chapter from the view that research can help to improve the work of all community psychiatrists and, likewise, that all community psychiatrists can help to improve health services research.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Afshar, M., Phillips, A., Karnik, N., Mueller, J., To, D., Gonzalez, R., Price, R., Cooper, R., Joyce, C., & Dligach, D. (2019). Natural language processing and machine learning to identify alcohol misuse from the electronic health record in trauma patients: Development and internal validation. Journal of the American Medical Informatics Association: JAMIA, 26(3), 254–261. https://doi.org/10.1093/jamia/ocy166
Balas, E. A., & Boren, S. A. (2000). Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics, 1, 65–70.
Ball, T. M., Stein, M. B., Ramsawh, H. J., Campbell-Sills, L., & Paulus, M. P. (2014). Single-Subject Anxiety Treatment Outcome Prediction using Functional Neuroimaging. Neuropsychopharmacology, 39(5), 1254–1261. https://doi.org/10.1038/npp.2013.328
Bauer, M. S., Damschroder, L., Hagedorn, H., Smith, J., & Kilbourne, A. M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(1). https://doi.org/10.1186/s40359-015-0089-9
Bell, C. C., & Mehta, H. (1980). The Misdiagnosis of Black Patients with Manic Depressive Illness. Journal of the National Medical Association, 72(2), 141–145.
Breiman, L. (2001). Statistical modeling: The two cultures (with comments and a rejoinder by the author). Statistical Science, 16(3), 199–231.
Bzdok, D., & Meyer-Lindenberg, A. (2018). Machine Learning for Precision Psychiatry: Opportunities and Challenges. Biological Psychiatry. Cognitive Neuroscience and Neuroimaging, 3(3), 223–230. https://doi.org/10.1016/j.bpsc.2017.11.007
Chandran, D., Robbins, D. A., Chang, C.-K., Shetty, H., Sanyal, J., Downs, J., Fok, M., Ball, M., Jackson, R., Stewart, R., Cohen, H., Vermeulen, J. M., Schirmbeck, F., de Haan, L., & Hayes, R. (2019). Use of Natural Language Processing to identify Obsessive Compulsive Symptoms in patients with schizophrenia, schizoaffective disorder or bipolar disorder. Scientific Reports, 9(1), 14146. https://doi.org/10.1038/s41598-019-49165-2
Chekroud, A. M., Zotti, R. J., Shehzad, Z., Gueorguieva, R., Johnson, M. K., Trivedi, M. H., Cannon, T. D., Krystal, J. H., & Corlett, P. R. (2016). Cross-trial prediction of treatment outcome in depression: A machine learning approach. The Lancet Psychiatry, 3(3), 243–250. https://doi.org/10.1016/S2215-0366(15)00471-X
Cruz, M., & Pincus, H. A. (2002). Research on the influence that communication in psychiatric encounters has on treatment. Psychiatric Services (Washington, D.C.), 53(10), 1253–1265. https://doi.org/10.1176/appi.ps.53.10.1253
Dixon, L. (2000). Assertive Community Treatment: Twenty-Five Years of Gold. Psychiatric Services, 51(6), 759–765. https://doi.org/10.1176/appi.ps.51.6.759
Doehrmann, O., Ghosh, S. S., Polli, F. E., Reynolds, G. O., Horn, F., Keshavan, A., Triantafyllou, C., Saygin, Z. M., Whitfield-Gabrieli, S., Hofmann, S. G., Pollack, M., & Gabrieli, J. D. (2013). Predicting Treatment Response in Social Anxiety Disorder From Functional Magnetic Resonance Imaging. JAMA Psychiatry, 70(1), 87. https://doi.org/10.1001/2013.jamapsychiatry.5
Drake, R. E., Bond, G. R., & Essock, S. M. (2009). Implementing Evidence-Based Practices for People With Schizophrenia. Schizophrenia Bulletin, 35(4), 704–713. https://doi.org/10.1093/schbul/sbp041
Essock, S. M., & Hogan, M. F. (2011). Looking Into the Health Reform Crystal Ball: Seeing More Constructive, Less Expensive Management Scenarios. American Journal of Psychiatry, 168(5), 449–451. https://doi.org/10.1176/appi.ajp.2011.11020205
Etkin, A., Patenaude, B., Song, Y. J. C., Usherwood, T., Rekshan, W., Schatzberg, A. F., Rush, A. J., & Williams, L. M. (2015). A Cognitive–Emotional Biomarker for Predicting Remission with Antidepressant Medications: A Report from the iSPOT-D Trial. Neuropsychopharmacology, 40(6), 1332–1342. https://doi.org/10.1038/npp.2014.333
Ford, C. L., & Airhihenbuwa, C. O. (2010). Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis. American Journal of Public Health, 100(S1), S30–S35. https://doi.org/10.2105/AJPH.2009.171058
Freedman, R., Lewis, D. A., Michels, R., Pine, D. S., Schultz, S. K., Tamminga, C. A., Gabbard, G. O., Gau, S. S.-F., Javitt, D. C., Oquendo, M. A., Shrout, P. E., Vieta, E., & Yager, J. (2013). The Initial Field Trials of DSM-5: New Blooms and Old Thorns. American Journal of Psychiatry, 170(1), 1–5. https://doi.org/10.1176/appi.ajp.2012.12091189
Friedman, C. P., Wong, A. K., & Blumenthal, D. (2010). Achieving a nationwide learning health system. Science Translational Medicine, 2(57), 57cm29. https://doi.org/10.1126/scitranslmed.3001456
Garfield, R. L., Zuvekas, S. H., Lave, J. R., & Donohue, J. M. (2011). The Impact of National Health Care Reform on Adults With Severe Mental Disorders. American Journal of Psychiatry, 168(5), 486–494. https://doi.org/10.1176/appi.ajp.2010.10060792
Gilbody, S. (2006). Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes. Archives of Internal Medicine, 166(21), 2314. https://doi.org/10.1001/archinte.166.21.2314
Goodfellow, I. J., Bengio, Y., & Courville, A. C. (2016). Deep Learning, ser. Adaptive computation and machine learning. MIT Press.
Green, L. W. (2008). Making research relevant: If it is an evidence-based practice, where’s the practice-based evidence? Family Practice, 25 Suppl 1, i20-24. https://doi.org/10.1093/fampra/cmn055
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations. The Milbank Quarterly, 82(4), 581–629. https://doi.org/10.1111/j.0887-378X.2004.00325.x
Hahn, T., Kircher, T., Straube, B., Wittchen, H.-U., Konrad, C., Ströhle, A., Wittmann, A., Pfleiderer, B., Reif, A., Arolt, V., & Lueken, U. (2015). Predicting Treatment Response to Cognitive Behavioral Therapy in Panic Disorder With Agoraphobia by Integrating Local Neural Information. JAMA Psychiatry, 72(1), 68. https://doi.org/10.1001/jamapsychiatry.2014.1741
Hirschfeld, R. M. A., Lewis, L., & Vornik, L. A. (2003). Perceptions and Impact of Bipolar Disorder: How Far Have We Really Come? Results of the National Depressive and Manic-Depressive Association 2000 Survey of Individuals With Bipolar Disorder. The Journal of Clinical Psychiatry, 64(2), 161–174. https://doi.org/10.4088/JCP.v64n0209
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
Hohmann, A. A., & Shear, M. K. (2002). Community-Based Intervention Research: Coping With the “Noise” of Real Life in Study Design. American Journal of Psychiatry, 159(2), 201–207. https://doi.org/10.1176/appi.ajp.159.2.201
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislow, C., & Wang, P. (2010). Research Domain Criteria (RDoC): Toward a New Classification Framework for Research on Mental Disorders. American Journal of Psychiatry, 167(7), 748–751. https://doi.org/10.1176/appi.ajp.2010.09091379
Institute of Medicine Committee on Quality of Health Care in America. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press (US).
Ioannidis, J. P. A. (2005). Why most published research findings are false. PLoS Medicine, 2(8), e124. https://doi.org/10.1371/journal.pmed.0020124
Ioannidis, J. P. A. (2016). Why Most Clinical Research Is Not Useful. PLoS Medicine, 13(6), e1002049. https://doi.org/10.1371/journal.pmed.1002049
Israel, B. A., Schulz, A. J., Parker, E., Becker, A., Allen, A. J., & Guzman, R. (2008). Critical issues in developing and following CBPR principles. Community-Based Participatory Research for Health: From Process to Outcomes, 47–66.
Jones, L., & Wells, K. (2007). Strategies for academic and clinician engagement in community-participatory partnered research. JAMA, 297(4), 407–410. https://doi.org/10.1001/jama.297.4.407
Khodayari-Rostamabad, A., Hasey, G. M., MacCrimmon, D. J., Reilly, J. P., & de Bruin, H. (2010). A pilot study to determine whether machine learning methodologies using pre-treatment electroencephalography can predict the symptomatic response to clozapine therapy. Clinical Neurophysiology, 121(12), 1998–2006. https://doi.org/10.1016/j.clinph.2010.05.009
Khodayari-Rostamabad, A., Reilly, J. P., Hasey, G. M., de Bruin, H., & MacCrimmon, D. J. (2013). A machine learning approach using EEG data to predict response to SSRI treatment for major depressive disorder. Clinical Neurophysiology, 124(10), 1975–1985. https://doi.org/10.1016/j.clinph.2013.04.010
Latimer, E. A. (1999). Economic Impacts of Assertive Community Treatment: A Review of the Literature. The Canadian Journal of Psychiatry, 44(5), 443–454. https://doi.org/10.1177/070674379904400504
Lohr, K. N., & Steinwachs, D. M. (2002). Health Services Research: An Evolving Definition of the Field. Health Services Research, 37(1), 15–17. https://doi.org/10.1111/1475-6773.01020
McGuire, T. G., & Miranda, J. (2008). New Evidence Regarding Racial And Ethnic Disparities In Mental Health: Policy Implications. Health Affairs, 27(2), 393–403. https://doi.org/10.1377/hlthaff.27.2.393
McHugo, G. J., Drake, R. E., Whitley, R., Bond, G. R., Campbell, K., Rapp, C. A., Goldman, H. H., Lutz, W. J., & Finnerty, M. T. (2007). Fidelity Outcomes in the National Implementing Evidence-Based Practices Project. Psychiatric Services, 58(10), 1279–1284. https://doi.org/10.1176/ps.2007.58.10.1279
National Institute of Mental Health Strategic Plan for Research (NIH Publication Number: 20-MH-8096; p. 48). (2020). https://www.nimh.nih.gov/about/strategic-planning-reports/goal-4-strengthen-the-public-health-impact-of-nimh-supported-research.shtml
Olfson, M., & Marcus, S. C. (2009). National Patterns in Antidepressant Medication Treatment. Archives of General Psychiatry, 66(8), 848. https://doi.org/10.1001/archgenpsychiatry.2009.81
Olfson, M., Marcus, S. C., Druss, B., Elinson, L., Tanielian, T., & Pincus, H. A. (2002). National trends in the outpatient treatment of depression. JAMA, 287(2), 203–209. https://doi.org/10.1001/jama.287.2.203
Olfson, M., Marcus, S. C., & Pincus, H. A. (1999). Trends in Office-Based Psychiatric Practice. American Journal of Psychiatry, 156(3), 451–457. https://doi.org/10.1176/ajp.156.3.451
Palinkas, L. A. (2014). Qualitative and Mixed Methods in Mental Health Services and Implementation Research. Journal of Clinical Child & Adolescent Psychology, 43(6), 851–861. https://doi.org/10.1080/15374416.2014.910791
Perna, G., Grassi, M., Caldirola, D., & Nemeroff, C. B. (2018). The revolution of personalized psychiatry: Will technology make it happen sooner? Psychological Medicine, 48(5), 705–713. https://doi.org/10.1017/S0033291717002859
Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation Research in Mental Health Services: An Emerging Science with Conceptual, Methodological, and Training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), 24–34. https://doi.org/10.1007/s10488-008-0197-4
Regier, D. A. (1978). The De Facto US Mental Health Services System: A Public Health Perspective. Archives of General Psychiatry, 35(6), 685. https://doi.org/10.1001/archpsyc.1978.01770300027002
Robbins, L., & Regier, D. A. (1991). Psychiatric Disorders in America: How to Take Immediate Control of Your Mental, Emotional, Physical and Financial. Simon & Schuster.
Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., Niederehe, G., Thase, M. E., Lavori, P. W., Lebowitz, B. D., McGrath, P. J., Rosenbaum, J. F., & Sackeim, H. A. (2006). Acute and Longer-Term Outcomes in Depressed Outpatients Requiring One or Several Treatment Steps: A STAR*D Report. Am J Psychiatry, 13.
Schooler, J. W. (2014). Metascience could rescue the ‘replication crisis.’ Nature, 515(7525), 9–9.
Schwartz, R. C., & Blankenship, D. M. (2014). Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry, 4(4), 133–140. https://doi.org/10.5498/wjp.v4.i4.133
Shalev-Shwartz, S., & Ben-David, S. (2014). Understanding machine learning: From theory to algorithms. Cambridge University Press.
Slade, E. P., McCarthy, J. F., Valenstein, M., Visnic, S., & Dixon, L. B. (2013). Cost Savings from Assertive Community Treatment Services in an Era of Declining Psychiatric Inpatient Use. Health Services Research, 48(1), 195–217. https://doi.org/10.1111/j.1475-6773.2012.01420.x
Sullivan, G., Duan, N., Mukherjee, S., Kirchner, J., Perry, D., & Henderson, K. (2005). The Role of Services Researchers in Facilitating Intervention Research. Psychiatric Services, 56(5), 537–542. https://doi.org/10.1176/appi.ps.56.5.537
Swain, K., Whitley, R., McHugo, G. J., & Drake, R. E. (2010). The Sustainability of Evidence-Based Practices in Routine Mental Health Agencies. Community Mental Health Journal, 46(2), 119–129. https://doi.org/10.1007/s10597-009-9202-y
Thomas, S. B., Quinn, S. C., Butler, J., Fryer, C. S., & Garza, M. A. (2011). Toward a Fourth Generation of Disparities Research to Achieve Health Equity. Annual Review of Public Health, 32(1), 399–416. https://doi.org/10.1146/annurev-publhealth-031210-101136
Wallerstein, N., Duran, B., Oetzel, J. G., & Minkler, M. (Eds.). (2018). Community-based participatory research for health: Advancing social and health equity (Third edition). Jossey-Bass.
Weisbrod, B. A., Test, M. A., & Stein, L. I. (1980). Alternative to mental hospital treatment. II. Economic benefit-cost analysis. Archives of General Psychiatry, 37(4), 400–405. https://doi.org/10.1001/archpsyc.1980.01780170042004
Whitfield-Gabrieli, S., Ghosh, S. S., Nieto-Castanon, A., Saygin, Z., Doehrmann, O., Chai, X. J., Reynolds, G. O., Hofmann, S. G., Pollack, M. H., & Gabrieli, J. D. E. (2016). Brain connectomics predict response to treatment in social anxiety disorder. Molecular Psychiatry, 21(5), 680–685. https://doi.org/10.1038/mp.2015.109
Wong, E. H. F., Yocca, F., Smith, M. A., & Lee, C.-M. (2010). Challenges and opportunities for drug discovery in psychiatric disorders: The drug hunters’ perspective. The International Journal of Neuropsychopharmacology, 13(09), 1269–1284. https://doi.org/10.1017/S1461145710000866
Wunderink, L., Sytema, S., Nienhuis, F. J., & Wiersma, D. (2009). Clinical Recovery in First-Episode Psychosis. Schizophrenia Bulletin, 35(2), 362–369. https://doi.org/10.1093/schbul/sbn143
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Goodsmith, N., Cruz, M. (2022). Mental Health Services Research and Community Psychiatry. In: Sowers, W.E., McQuistion, H.L., Ranz, J.M., Feldman, J.M., Runnels, P.S. (eds) Textbook of Community Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-031-10239-4_30
Download citation
DOI: https://doi.org/10.1007/978-3-031-10239-4_30
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-10238-7
Online ISBN: 978-3-031-10239-4
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)