Abstract
The first paragraph of the first chapter of David Speer's slim but action-packed volume on mental health outcome evaluation provides a litmus test of its suitability for prospective readers. What response do you have to the author's answer to his rhetorical chapter heading: ‘Why evaluate mental health service outcomes?’
The current national apprehension about the spiraling costs of health care pervades almost every aspect of American society. Congress is preoccupied with the implications for the national deficit of Medicare, Medicaid, and government employees health insurance costs. State governments have similar concerns. Employers see employee health insurance costs eroding their profit margins. The insurance industry struggles to balance affordable premiums and escalating health care costs.
This goes on for a while longer in similar vein. If you feel that mental health outcome evaluation has something to do with improving services for patients rather than managers, and/or the current system of American healthcare delivery concerns you, then this is the wrong book. It is unapologetically written for ‘nonscientist decisionmakers and professionals’, not clinicians. It also has a strong American bias, both in the research it cites and around its central argument that outcome evaluation is an essential component of managed mental health care. Conversely, if you buy the argument that outcome evaluation and service accountability go hand-in-hand, and that America leads the world in this area, you will learn a lot from this book.
In 121 pages, Speer provides a clear, practical, introduction to mental health outcome evaluation that achieves considerable richness and depth. His writing is yankee-casual in style but precise in content. The chatty chapter headings provide a flavour: ‘Why evaluate mental health service outcomes?’; ‘A different perspective: practical outcome evaluation’; ‘So, how do we tell if something works?’ (a lucid account of methodology); ‘What should be measured?’; ‘Potential booby traps and landmines’; ‘Practical implementation issues and suggestions’; and, ‘In conclusion, shouldn't every-one evaluate outcomes?’ He is particularly strong on barriers to effective evaluation and provides good suggestions for evaluation tools appropriate to different clinical situations.
In short, within its constraints, I am not aware of a better short text on this subject. It is regrettable that the particular slant that the author brings to the book will inevitably limit his Australasian readership; its usefulness may well extend beyond his target audience.