Evaluation of social, mental health, and public health programs are challenging, for many reasons.  Our readings for this week discuss and highlight some of these challenges.  Which challenges are especially important to address, in evaluating these programs?
SPECIAL ARTICLE
New trends in assessing the outcomes of mental
health interventions
GRAHAM THORNICROFT, MIKE SLADE
King’s College London, Health Service and Population Research Department, Institute of Psychiatry, Denmark Hill, London SE5 8AF, UK
Assessing the outcomes of interventions in mental health care is both important and challenging. The aim of this paper is to advance the
field of outcomes research by proposing a taxonomy of the decisions that clinicians and researchers need to consider when evaluating
outcomes. Our taxonomy has eight components, framed as decisions: Whose outcome will be considered? Which scientific stage is being
investigated? What outcome domain(s) matter? What level of assessment will be used? Will clinical and/or recovery outcomes be assessed?
Whose perspective will be considered? Will deficits and/or strengths be the focus? Will invariant or individualized measures be preferred?
We propose a future focus on understanding what matters most to people using mental health services, and on the use of measures rated by
service users as the primary approach to evaluating outcome.
Key words: Outcomes research, assessment measures, mental health services research
(World Psychiatry 2014;13:118–124)
Assessing the outcomes of interventions in mental health
care is both important and challenging. It is important
because producing significant outcomes, i.e., health gains
attributable to an intervention (1), is the main goal of mental
health services. Other important attributes of an intervention, such as accessibility, acceptability, efficiency and costeffectiveness, need only to be considered where the intervention produces significant outcomes. Assessing outcomes
is also challenging, because choosing methods, outcome
domains and outcome measures all involve the balancing of
conceptual, ethical and clinical considerations (2,3).
The aim of this paper is to propose a taxonomy of the
decisions that clinicians and researchers need to consider
when evaluating outcomes. Our taxonomy has eight components, each of which involves making explicit underpinning assumptions. We therefore frame these components as
decisions.
DECISION 1: WHOSE OUTCOME?
I