Theory generation and practice improvement: a mental health service perspective

Abstract

This article presents findings from four problem-based research sites that comprise a larger action research project within primary care mental health services. The projects explored in this article are ongoing and involve working with small networks within specific areas: a GP practice counseling service, a Community Mental Health Team, a GP attached social worker scheme and a rural health cross-disciplinary team. By taking a constructivist approach, and through use of grounded theory techniques, the findings share some common features with Action Research and demonstrate two key aims of problem-based methodology, mainly practice improvement and theory generation (Robinson, 1993). First, they illustrate that a particular understanding of mental health service users can be reached from exploring the way in which they are excluded. Four excluded identities are presented (absent, mediated, difficult and elusive). Secondly, within the understanding that the success of problem-based research can be determined by the effectiveness of actions taken in the local setting (Edwards & Talbot, 1994), the article explores how reflection of user perspectives can move the research forward. Actions taken to improve the service include incremental changes and new initiatives, as well as the development of new avenues of research, thus adding to other action research within healthcare services (Hart & Bond, 1997).