A voice for all in mental health research

As noted in a recent Editorial (Rose, 2011), The Journal of Mental Health has an unsurpassed tradition of publishing papers that articulate the perspectives of mental health service use researchers and of service users. The perspectives of health professionals (Wells, 2011) and carers (Hughes et al., 2011) have also featured prominently in the journal and there has been a longstanding commitment to highlighting the stigma that continues to detract from the lives of individuals with mental disorders, their families and the community as a whole (Ben-Seev et al, 2010). These contributions appear alongside developments in clinical practice, epidemiological research, psychometric analysis and health promotion.

The journal encourages multi-disciplinary collaboration, welcomes qualitative, quantitative and mixed-methods research, is receptive to ideas that challenge currently dominant approaches to the classification and treatment of mental health problems and publishes theoretical papers, reviews and commentaries, in addition to research articles, from contributors in all corners of the globe. In other words, there is little in the way of preconceptions as to the kind of research or researchers who have the potential to improve our understanding of mental health and mental health care.

It has been argued, cogently I believe, that a “top-down” approach to the delivery of mental health care, in which the views of health professionals concerning the nature, causes and treatment of mental illness are merely imposed upon those of service users, is a recipe for failure (Jorm et al., 2000). Rather, the attitudes and beliefs of service users, those with whom they interact and the community as a whole need to be considered in efforts to improve clinical practice and mental health care more generally.

The same might be said of mental health research. “Evidence-based practice” is fine in theory, but it needs to be recognised that there are many forms of evidence likely to be of benefit in informing mental health care and that judgments as to which particular forms are more or less worthy of attention are necessarily subjective. Certainly randomised-controlled trials are valuable, but they are not and should not be viewed as the be all and end all in clinical research (Patterson et al, 2010). Along similar lines the DSM, dominant as it is, is just one, far from perfect, possible approach to classification (Wykes & Callard, 2010).

In my view, it would be better for both researchers and clinicians to acknowledge the limitations of all forms of evidence relating to the treatment of mental disorders than to dogmatically assert the superiority of one form or evidence – or treatment – over another. After all, issues fundamental to mental health care, such as the relative importance to outcome of the therapeutic alliance versus the treatment modality, remain unresolved and there may never be definitive answers to such questions.

In a world in which the medical model of mental illness is so pervasive, a forum in which the perspectives of all those with an interest in or experience of mental health care are welcome is both refreshing and necessary. At the very least, mental health researchers should be able to cast a critical eye over currently dominant paradigms without feeling marginalised.

On a more personal note, I am delighted that the journal has seen fit to publish work by my colleagues and I in the field of eating disorders “mental health literacy” (Mond et al., 2006, 2008). An overarching theme of this research is to allow the public – including and especially those with symptoms – to give their thoughts about the nature and meaning of eating-disordered behaviour and how it should be treated. Upon reflection, I wish that I had been less dogmatic myself in evaluating those thoughts.

A second stream of research, which has also found a place in the journal (Hay & Mond, 2005; Mond et al., 2011), has focused on impairment in mental health associated with the spectrum of eating-disordered behaviour that occurs at the population level. Elsewhere (Mond et al., 2007, 2009, 2011), we have drawn attention to the role of body dissatisfaction and eating-disordered behaviour – and of mental health issues more generally – in the context of the “obesity epidemic”, a role that appears to have been largely ignored in public health discourse.

My experience is that eating-disordered behaviour is apt to get short shrift as a mental health issue – let alone as a public health problem – and I know that many in the field remain frustrated that eating disorders research is not given, or given only grudgingly, a voice in psychiatry and public health journals. Contributors will find me sympathetic to efforts that seek to redress this imbalance.

More generally though, and consistent with the mission of the journal, contributors will find me receptive to any and all thoughtful, original research that has the potential to reduce the individual and community health burden of poor mental health. I am proud to be a member of the Editorial Board of such a progressive, egalitarian forum and look forward to working more closely with other board members, contributors and readers.