Description and classification of mental health services: a European perspective

Whilst steady progress has been made in the development and dissemination o f valid and reliable instruments for evaluation of patient outcomes, progre ss in establishing standard methodologies for description and classificatio n of mental health services has been limited. Valid and reliable methods of describing and classifying services are needed in mental health services r esearch for purposes including; i) comparison of levels of provision betwee n catchment areas and countries; ii) reaching an understanding of the relat ionship between socio-demographic indicators and service use; iii) investig ation of the degree to which one service may be substituted for another; iv ) evaluating programme implementation; and v) understanding why different o utcomes are observed from apparently similar treatment programmes. Where pr ogrammes of research encompass different countries, the need for methods of comparing the local service contexts is particularly acute. In this paper, the various contributions which have been made to the somewhat fragmented body of research in this area are reviewed, and the problems which have ham pered the development of satisfactory instruments are discussed. A set of c riteria for satisfactory service measurement methodologies is proposed: the se include development of standard nomenclature and operational definitions of service types; clear demonstration of validity and reliability; compreh ensiveness; and applicability and similar interpretation in a range of coun tries. (C) 1998 Elsevier, Paris.