Mental health services research methodology

Abstract

Evidence-based mental health is an important goal, and randomized controlled trials (RCTs) are currently used as the currency. Significant gains have been made in overcoming technical difficulties with RCTs, but conceptual issues with the use of RCTs as 'best' evidence can also be identified. Some limits of RCTs for research into individual patients, local services, and national policy will be identified. The central thesis is that RCTs have an important contribution to make, but are only one form of evidence. Another framework for research--realistic evaluation--is described, in which the context and mechanisms of action are considered, as well as the outcome. Realistic evaluation will lead to different forms of evidence, including but not limited to RCTs, and will be more illuminating for some research questions than solely considering RCTs.