QUALITY OF MENTAL-HEALTH-SERVICE CARE - THE FORGOTTEN PATHWAY FROM PROCESS TO OUTCOME

The validity of the concept of outcome depends on a relationship betwe en routine treatment and later health status. Outcome evaluations and audits are very rare in psychiatry. A substantial expansion in epidemi ologically based, naturalistic, observational, process-outcome data co llection in routine psychiatric practice is essential in order to iden tify treatment allocation biases and other reasons for unexpected outc omes. Identified causes of undertreatment should lead to locally agree d detailed clinical guidelines. Experimental evaluation should take pl ace in routine clinical practice settings, with change in both process and outcome as the objective, Ultimately, the results of both experim ental and observational outcome studies on representative service user s should converge, permitting outcomes to be the ultimate arbitrator o f quality.