Objective: Current mental health policies emphasise the need for services to be integrated and to develop outcomes-based evaluation systems. An overview of the challenges faced by service managers and clinical academics who develop the appropriate financial, personnel and academic infrastructure for these tasks is presented.
Method: By drawing on experiences within the St George Service and references to other services, we propose a model for a successful partnership between the academic and management components of a district service.
Results: Major logistic impediments to the development of a partnership are identified, although the long-term scientific and service delivery benefits are highlighted. Key areas within both academic practice and managerial approaches requiring transformation are discussed.
Conclusions: A successful long-term partnership between management and an academic department within a district service may provide the opportunity for rapid progress in population-based service evaluation and health outcomes research.
Commonwealth Department of Human Services and Health.National goals, targets, and strategies for mental health. In: Better health outcomes for Australians: national goals, targets and strategies for better health outcomes into the next century. Canberra: Australian Government Publishing Service, 1994:247–274.
2.
Centre for Mental Health.Caring for mental health: draft strategic plan for mental health in NSW. North Sydney: NSW Department of Health, 1996.
3.
JenkinsR.Towards a system of outcome indicators for mental health care. British Journal of Psychiatry1990; 157:500–514.
4.
SnaithRPMeasurement in psychiatry. British Journal of Psychiatry1991; 159:78–82.
5.
AndrewsGPetersLTeesonM.The measurement of consumer outcome in mental health. Canberra: Australian Government Publishing Service, 1994.
6.
PincusHAResearch and clinical training in psychiatry: inputs and outputs. Psychiatric Quarterly1991; 62:121–131.
7.
LiebermanJARushAJRedefining the role of psychiatry in medicine. American Journal of Psychiatry1996; 153:1388–1397.
8.
LazarusLBraithwaiteJWestbrookJIHealth outcomes: of means and ends. Medical Journal of Australia1995; 162:4–5.
9.
RushAJAssessing outcome in practice: a paradigm shift?Current Opinion in Psychiatry1996; 9:1–2.
10.
LichtRWGouliaevGVestergaardPFrydenbergM.Generalisability of results from randomised drug trials. British Journal of Psychiatry1997; 170:264–267.
11.
BrughaTSLindsayF.Quality of mental health service care: the forgotten pathway from process to outcome. Social Psychiatry and Psychiatric Epidemiology1996; 31:89–98.
12.
DunnG.Statistical methods for measuring outcomes. Social Psychiatry and Psychiatric Epidemiology1994; 29:198–204.
13.
BruceMLLeafPJRozalGPMFlorioLHoffRAPsychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area Study. American Journal of Psychiatry1994; 151:716–721.
14.
SartoriusNUstunTBLecrubierYWittchenH-U.Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care. British Journal of Psychiatry1996; 168(Suppl. 30):38–43.
15.
WellsKBStewartAHaysRDThe functioning and well-being of depressed patients. Results from the medical outcome study. Journal of the American Medical Association1989; 262:914–919.
16.
AngstJ.Comorbidity of mood disorders: a longitudinal prospective study. British Journal of Psychiatry1996; 168(Suppl. 30):31–37.
17.
BrownCSchulbergHCMadoniaMJShearMKHouckPRTreatment outcomes for primary care patients with major depression and lifetime anxiety disorders. American Journal of Psychiatry1996; 153:1293–1300.
18.
Depression Guideline Panel.Depression in primary care, Vol. 2. Treatment of major depression. Clinical practice guideline, Number 5. Rockville, MD: US Department of Health and Human Services, Public Health Service, 1993.
19.
GoldbergD.A dimensional model for common mental disorders. British Journal of Psychiatry1996; 168(Suppl. 30):44–49.
20.
KatonWRobinsonPvon KorffMA multifaceted intervention to improve treatment of depression in primary care. Archives of General Psychiatry1996; 53:924–932.
21.
KesslerRCNelsonCBMcGonagleKALiuJSwartzMBlazerDGComorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. British Journal of Psychiatry1996; 168(Suppl. 30):17–30.
22.
MasonPWilkinsonG.The prevalence of psychiatric morbidity. OPCS survey of psychiatric morbidity in Great Britain. British Journal of Psychiatry1996; 168:1–3.
23.
MerikangasKRAngstJEatonWComorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. British Journal of Psychiatry1996; 168(Suppl. 30):58–67.
24.
Mynors-WallisLDaviesIGrayABarbourFGathD.A randomised controlled trial and cost analysis of problem-solving treatment for emotional disorders given by community nurses in primary care. British Journal of Psychiatry1997; 170:113–119.
25.
SchulbergHCBlockMRMadoniaMJTreating major depression in primary care practice: eight-month clinical outcomes. Archives of General Psychiatry1996; 53:913–919.
26.
ScottCTacchiMJJonesRScottJ.Acute and one-year outcome of a randomised controlled trial of brief cognitive therapy for major depressive disorder in primary care. British Journal of Psychiatry1997; 171:131–134.
27.
UstunTBSimonGSartoriusN.Discussion. In: UstunTBSartoriusN, eds. Mental illness in general health care: an international study. Chichester: John Wiley, 1995:361–369.
28.
BatesDWSchmittWBuchwaldDPrevalence of fatigue and chronic fatigue syndrome in a primary care practice. Archives of Internal Medicine1993; 153:2759–2765.
29.
BuchwaldDSullivanJLKomaroffALFrequency of ‘chronic active Epstein–Barr virus infection’ in a general medical practice. Journal of the American Medical Association1987; 257:2303–2307.
30.
CathebrasPJRobbinsJMKirmayerLJHaytonBCFatigue in primary care: prevalence, psychiatric comorbidity, illness behaviour, and outcome. Journal of General Internal Medicine1992; 7:276–286.
31.
DavidAPelosiAMcDonaldETired, weak, or in need of rest: fatigue among general practice attenders. British Medical J ournal1990; 301:1199–1202.
32.
GoldenbergDLFibromyalgia, chronic fatigue syndrome, and myofascial pain. Current Opinions in Rheumatology1996; 8:113–123.
33.
HickieIBHookerAWHadzi-PavlovicDBennettBKWilsonAJLloydARFatigue in selected primary care settings: sociodemographic and psychiatric correlates. Medical Journal of Australia1996; 164:585–588.
34.
KettellJJonesRLydeardS.Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics. British Journal of General Practice1992; 42:459–461.
35.
KroenkeKWoodDRMangelsdorffADMeierNJPowellJBChronic fatigue in primary care: prevalence, patient characteristics, and outcome. Journal of the American Medical Association1988; 260:929–934.
36.
OwensDMNelsonDKTalleyNJThe irritable bowel syndrome: long-term prognosis and the physician–patient interaction. Annals of Internal Medicine1995; 122:107–112.
37.
PawlikowskaTChalderTHirschSRWallacePWrightDJMWesselySCPopulation based study of fatigue and psychological distress. British Medical Journal1994; 308:763–766.
38.
HickieIHadzi-PavlovicDRicciC.Reviving the diagnosis of neurasthenia. Psychological Medicine1997; 27:989–994.
39.
von KorffMSimonG.The relationship between pain and depression. British Journal of Psychiatry1996; 168(Suppl. 30):101–108.
40.
HickieILloydAWakefieldD.Chronic fatigue syndrome: current perspectives on evaluation and management. Medical Journal of Australia1995; 163:314–318.
41.
JonesRLydeardS.Irritable bowel syndrome in the general population. British Medical Journal1992; 304:87–90.
42.
TalleyNJZinsmeisterARMeltonLJIIIIrritable bowel syndrome in a community: symptom subgroups, risk factors, and health care utilization. American Journal of Epidemiology1995; 142:76–83.
43.
WilsonAHickieILloydAWakefieldD.Science and speculation: the treatment of chronic fatigue syndrome. American Journal of Medicine1994; 96:544–550.
44.
CoffeyCEFigielGSDjangWTWeinerRDSubcortical hyperintensity on magnetic resonance imaging: a comparison of normal and depressed elderly subjects. American Journal of Psychiatry1990; 147:187–189.
45.
CoffeyCEWilkinsonWEWeinerRDQuantitative cerebral anatomy in depression: a controlled magnetic resonance imaging study. Archives of General Psychiatry1993; 50:7–16.
46.
HickieIScottE.Late-onset depression disorders: a preventable variant of cerebrovascular disease?Psychological Medicine1998 (in press).
47.
HickieIScottEMitchellPWilhelmKAustinMPBennettB.Subcortical hyperintensities on magnetic resonance imaging: clinical correlates and prognostic significance in patients with severe depression. Biological Psychiatry1995; 37:151–160.
48.
HickieIScottEWilhelmKBrodatyH.Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression: a longitudinal evaluation. Biological Psychiatry1997; 42:367–374.
49.
KrishnanKRRNeuroanatomic substrates of depression in the elderly. Journal of Geriatric Psychiatry and Neurology1993; 6:39–58.
50.
KrishnanKRRHaysJCBlazerDGMRI-defined vascular depression. American Journal of Psychiatry1997; 154:497–501.
51.
LesserIMBooneKBMehringerCMWohlMAMillerBLBermanNGCognition and white matter hyperintensities in older depressed patients. American Journal of Psychiatry1996; 153:1280–1287.
52.
LesserIMMenaIBooneKBMillerBLMehringerCMWohlMAReduction of cerebral blood flow in older depressed patients. Archives of General Psychiatry1994; 51:677–686.
53.
MaybergHSNeuroimaging studies of depression in neurologic disease. In: StarksteinSERobinsonRG, eds. Depression in neurologic disease. Baltimore: Johns Hopkins University Press, 1993:186–216.
54.
AndreasenNCArndtSSwayzeVThalamic abnormalities in schizophrenia visualized through magnetic resonance image averaging. Science1994; 266:294–298.
55.
ChuaSEWrightICPolineJ-BGrey matter correlates of syndromes in schizophrenia. British Journal of Psychiatry1997; 170:406–410.
56.
DupontRMJerniganTLButtersNSubcortical abnormalities detected in bipolar affective disorder using magnetic resonance imaging. Archives of General Psychiatry1990; 47:55–59.
57.
HawleyCJQuickSJHardingMJPattinsonHSivakumaranT.A preliminary study to examine the adequacy of long-term treatment of depression and the extent of recovery in general practice. British Journal of General Practice1997; 47:233–234.
58.
TiemansBGOrmelJSimonGEOccurrence, recognition, and outcome of psychological disorders in primary care. American Journal of Psychiatry1996; 153:636–644.
59.
KiselySRGoldbergDPThe effect of physical ill health on the course of psychiatric disorder in general practice. British Journal of Psychiatry1997; 170:536–540.
60.
GoldmanLNeillJRosenblattM.The business of education: a new paradigm. Physician Executive1997; 23:21–24.
61.
AitchisonKJKerwinRWCost-effectiveness of clozapine. British Journal of Psychiatry1997; 171:125–130.
62.
BeckACroudaceTJSinghSHarrisonG.The Nottingham acute bed study: alternatives to acute psychiatric care. British Journal of Psychiatry1997; 170:247–252.
63.
FontanaARosenheckR.Effectiveness and cost of the inpatient treatment of posttraumatic stress disorder: comparison of three models of treatment. American Journal of Psychiatry1997; 154:758–765.
64.
LyonsJSO'MahoneyMTMillerSINemeJKabatJMillerF.Predicting readmission to the psychiatric hospital in a managed care environment: implications for quality indicators. American Journal of Psychiatry1997; 154:337–340.
65.
MellsopGWBlair-WestGWDuraiappahV.The effect of a new integrated mental health service on hospitalisation. Australian and New Zealand Journal of Psychiatry1997; 31:480–483.
66.
RobertGKennedyP.Establishing cost-effectiveness of atypical neuroleptics. British Journal of Psychiatry1997; 171:103–104.
67.
Vazquez-BarqueroJLGarciaJSimonJAMental health in primary care: an epidemiological study of morbidity and use of health resources. British Journal of Psychiatry1997; 170:529–535.
68.
WolffNHelminiakTWMorseGACalsynRJKlinkenbergWDTrustyMLCost-effectiveness evaluation of three approaches to case management for homeless mentally ill clients. American Journal of Psychiatry1997; 154:341–348.
69.
GabbardGOLazarSGHornbergerJSpiegelD.The economic impact of psychotherapy: a review. American Journal of Psychiatry1997; 154:147–155.
70.
GaskLSibbaldBCreedF.Evaluating models of working at the interface between mental health services and primary care. British Journal of Psychiatry1997; 170:6–11.
71.
GrayAMMarshallMLockwoodAMorrisJ.Problems in conducting economic evaluations alongside clinical trials: lessons from a study of case management for people with mental disorders. British Journal of Psychiatry1997; 170:47–52.
72.
KernickDPWhich antidepressant? A commentary from general practice on evidence-based medicine and health economics. British Journal of General Practice1997; 47:95–98.
73.
LangFHForbesJFMurrayGDJohnstoneECService provision for people with schizophrenia: I. Clinical and economic perspective. British Journal of Psychiatry1997; 171:159–164.
74.
LivingstoneGManelaMKatonaC.Cost of community care for older people. British Journal of Psychiatry1997; 171:56–69.
75.
SabinJEAcademic psychiatry and managed care. Psychiatric Services1997; 48:985.
76.
SalizeHJRosslerW.The cost of comprehensive care of people with schizophrenia living in the community: a cost evaluation from a German catchment area. British Journal of Psychiatry1996; 169:42–48.
77.
SharfsteinSSCost-effectiveness of psychiatric care. American Journal of Psychiatry1997; 154:723–724.
78.
WetzlerSSchwartzBJSandersonWKarasuTBAcademic psychiatry and managed care: a case study. Psychiatric Services1997; 48:1019–1026.
79.
WolffNHelminiakTWTebesJKGetting the cost right in cost-effectiveness analyses. American Journal of Psychiatry1997; 154:736–743.
80.
CommanderMJDharanSashi SPOdellSMSurteesPGAccess to mental health care in an inner-city health district. 1: Pathways into and within specialist psychiatric services. British Journal of Psychiatry1997; 170:312–316.
81.
CommanderMJDharanSashi SPOdellSMSurteesPGAccess to mental health care in an inner-city health district. II: Association with demographic factors. British Journal of Psychiatry1997; 170:317–320.
82.
KrawitzRWatsonC.Gender, race and poverty: bringing the sociopolitical into psychotherapy. Australian and New Zealand Journal of Psychiatry1997; 31:474–479.
83.
MattheySBarnettBEWElliottA.Vietnamese and Arabic women's responses to the Diagnostic Interview Schedule (depression) and self-report questionnaires: cause for concern. Australian and New Zealand Journal of Psychiatry1997; 31:360–369.
84.
MinasIHPsychiatric services research in a multicultural society. In: Cultural diversity and mental health. Melbourne: Royal Australian and New Zealand College of Psychiatry and Victorian Transcultural Psychiatry Unit, 1991:35–51.
85.
MinasIHLambertTJRRostovSBorangaG.Mental health services for NESB immigrants: transforming policy into practice. Canberra: Australian Government Publishing Service, 1996.
86.
PhanTSiloveD.The influence of culture on psychiatric assessment: the Vietnamese refugee. Psychiatric Services1997; 48:86–90.
87.
SeverinoSKChungH.Health care reform: implications for academic psychiatric institutions. Journal of Mental Health Administration1995; 22:77–84.
88.
SiloveDManicavasagarVBeltranRSatisfaction of Vietnamese patients and their families with refugee and mainstream mental health services. Psychiatric Services1997; 48:1064–1069.
89.
HoultJReynoldsI.Schizophrenia: a comparative trial of community orientated and hospital orientated psychiatric care. Acta Psychiatrica Scandanavica1984; 69:359–372.
90.
ParkerG.Public mental health service delivery: a modified model. Australasian Psychiatry1997; 5:167–169.
91.
HaweP.Needs assessment must become more change-focused. Australian and New Zealand Journal of Public Health1996; 20:473–478.
92.
AndersonJTrauerT.Comment: ‘As simple as possible, but not simpler.’Australian and New Zealand Journal of Psychiatry1997; 31:484–487.
93.
SteinwachsDMServices systems research. Schizophrenia Bulletin1992; 18:627–668.
94.
BrillPLLishJDGrissomGRTiming is everything: pre–post versus concurrent measurement. Behavioral Healthcare Tomorrow1995; 4:76–81.
95.
CarpinelloSENewmanDIJatulisLLHealth decision makers’ perceptions of program evaluation. Evaluation and the Health Professions1992; 15:405–419.
96.
SmithGRJr.FischerEPNordquistCRMosleyCLLedbetterNSImplementing outcomes management systems in mental health settings. Psychiatric Services1997; 48:364–368.
97.
OsbourneOHHagerottRJHilliardIThomasMDA state–university collaboration to improve state hospital nursing care. Hospital and Community Psychiatry1992; 43:1040–1041.
98.
PettiTAComelyPJSonisMBoardG.State–university collaboration to enhance public psychiatric services in Western Pennsylvania. Hospital and Community Psychiatry1992; 43:996–1000.
99.
WeitekampMRThorndykeLEEvartsCMStrategic planning for academic health centers. American Journal of Medicine1996; 101:309–315.
100.
MorrisP.Managed care: a personal view. Australasian Psychiatry1997; 5:127–128.
101.
TobinMJDakosTUrbancA.Using action research to facilitate organisational change in mental health service delivery. Australian and New Zealand Journal of Psychiatry1997; 31:739–743.
102.
PaiSKapurRLThe burden on the family of a psychiatric patient: development of an interview schedule. British Journal of Psychiatry1981; 138:332–335.
103.
RosenAHadzi-PavlovicDParkerG.The Life Skills Profile: a measure assessing function and disability in schizophrenia. Schizophrenia Bulletin1989; 15:325–337.
104.
BurnsT.Case management, care management and care programming. British Journal of Psychiatry1997; 170:393–395.
105.
MarshallMLockwoodAGathD.How effective is social services case management for people with long-term mental disorders? A randomised controlled trial. Lancet1995; 345:409–412.
106.
RidgelyMSMorrisseyJPPaulsonRIGoldmanHHCallowayMOCharacteristics and activities of case managers in the RWJ Foundation Program on Chronic Mental Illness. Psychiatric Services1996; 47:737–743.
107.
SantosABHenggelerSWBurnsBJAranaGWMeislerN.Research on field-based services: models for reform in the delivery of mental health care to populations with complex clinical problems. American Journal of Psychiatry1995; 152:1111–1123.
108.
TobinMHickieIBUrbancA.Increasing general practitioner skills with patients with serious mental illness. Australian Health Review1997; 20:55–67.
109.
American Psychiatric Association.Diagnostic and statistical manual of mental disorders, 4th edn.Washington DC: American Psychiatric Association, 1994.
110.
FarmerAOwenMJGenomics: The next psychiatric revolution?British Journal of Psychiatry1996; 169:135–138.
111.
BirchwoodMMcGorryPJacksonH.Early intervention in schizophrenia. British Journal of Psychiatry1997; 170:2–5.
