Mental Health Services as Complex Interventions
Being in Germany is an apt reminder of the German origin of the term ‘Gestalt’, often interpreted as ‘the whole is greater than the sum of its parts’.
In this keynote, I will argue that mental health services are complex systems that are greater than the sum of their parts and that mental health services can be treated as interventions in their own right. Examples of the ‘parts’ of a mental health service include: referral methods into the service; the interventions delivered; the numbers, training and attitudes of staff; user perceptions of the service; and ecological features of the service such as its location and the buildings and any technology used to facilitate delivery. Too often, healthcare research focuses on the effectiveness of specific interventions (a part) rather than the effectiveness of the mental health service as a system (the whole).
Making reference to some funded UK mental health services research – including work on mental health services for children and young people that I have been involved in – I will outline how complexity in mental health services can be successfully studied using mixed methods approach that combine methods as diverse as systematic review, meta-analysis, survey techniques, ‘netnography’ and case study research.
I will also discuss some of the conceptual and practical difficulties in conducting mental health services research (e.g. defining key concepts like ‘service’ or ‘service model’) while simultaneously arguing that mixed methods research has considerable value in helping commissioners and providers design and deliver effective mental health services.