The ethical base of mental health service research. Recent developments inmental health service research in the UK

After the developments in mental health services in the UK in the last 40 y ears there has been an increasing focus on identifying and targeting the ne eds of the severely mentally ill (SMI). Political concern about the possibl e risks of community care have resulted in an emphasis on administrative an d legal means of ensuring continuity of care and close clinical supervision of this SMI group. A number of experimental community-oriented mental heal th services have been shown to be cost-effective compared to hospital-based treatment. The further development of comprehensive community mental healt h services will depend on demonstrating whether this can be generalised to routine clinical settings. In this context we shall present the design of t he PRiSM study, a prospective controlled trial of the cost-effectiveness of community mental health teams for the SMT in South London.