Clinical psychology owes its status as a profession, including its independence of psychiatry and its eligibility for third-party payments, to the assumption that its practices are firmly grounded on scientifically validated theories and techniques. Accordingly, just as the practice of medicine is grounded on basic sciences such as anatomy, physiology, and pharmacology, the practice of clinical psychology is grounded in basic psychological science which details the biological, cognitive-affective, individual, and social bases of mind and behavior, along with various aspects of clinical science such as descriptive and experimental psychopathology, psychometrics and personality assessment, and psychotherapy process and outcome (Kihlstrom & Canter Kihlstrom, 1998). This was true in 1949, with the establishment of the Boulder model of the scientist-practitioner, and it remains true as alternative training models have emerged.
However, clinical psychology is now practiced in an increasingly complicated and demanding environment. Accordingly, a new field of interdisciplinary research has emerged, which seeks to elucidate the structure, processes, and effects of mental health services provided to individuals and special populations. We want to argue that mental health services research is a new science for clinical practice; that it should occupy a central place in clinical training curricula, alongside the traditional basic sciences; and that psychologists should participate in this field more actively than they currently do.
Early on in its development, mental health services research focused heavily on the cost of care, and it was influenced by economists. But the field has now expanded to combine approaches from a number of other fields, including anthropology, epidemiology, management science, political science, and sociology, as well as psychology. In fact, like cognitive science, mental health services research now constitutes its own interdisciplinary field with its own departments, doctoral programs, professional organizations, and journals. The newer wave of recently trained services researchers argues that economic theory provides only one perspective, and demands that broader social and behavioral science theories be incorporated into services research.
Mental health services research also has expanded to cover a wide variety of topics (Canter Kihlstrom, 1998). The mental health field is no longer a matter of clinicians and patients, hospitals and private practices. A vast array of organizations now provide mental health services, delivered by a variety of professionals, and mental health services research seeks to understand how these organizational forms, and the people in them, interact with each other. And the rise of health insurance, and demands for parity for mental health services, has increased the complexity of issues surrounding the cost and financing of care: Who will pay for mental health services, and under what circumstances? What impact will managed care have on costs? How do we pay for the utilization of mental health services by the uninsured? Do the costs of mental health care offset the costs of general medical care? Services research also asks questions about access to mental health services. While some individuals certainly encounter financial barriers to obtaining adequate service, researchers have also begun to document the role of geographic, sociocultural, organizational, and other nonfinancial factors in determining access. There is a growing emphasis on the needs of special populations, such as children, the elderly, ethnic minorities, persons with severe mental illness, and those in the criminal justice system: Are they getting access to the mental-health care they need?
Equally important, mental health services researchers have begun to redefine the concept of access, away from an emphasis on mere utilization to consider individual perceptions, demographic characteristics, organizational practices, and delivery system attributes. Last, but not least, service researchers have begun to tackle the issue of quality of care. Consumers of mental health services have always been concerned with the effects of treatment, of course. But in an era of third-party payments, government agencies, insurers, and employers have taken an increasing interest in whether treatments are appropriate, and whether their outcomes justify their costs. In the final analysis, then, mental health services are no longer evaluated simply in terms of cost and access, but, equally important, in terms of whether treatment works in a way that is measurably valuable in terms of the individual's physical and psychological health, level of independence, social relationships, and environment. A major theme running throughout all of these topics is the increased role that psychological and other social-scientific theories should play in services research.
Although many psychologists are engaged in mental health services research, along with other behavioral and social scientists, this multidisciplinary field remains relatively unknown in the psychological community. We hope that this symposium will help psychologists to become better acquainted with an area of research that will have an increasing impact on professional practice. And we also hope that it will stimulate both basic and applied researchers to become more involved in services research.
Introduction to a symposium, "Mental Health Services Research: A New Science for Practice", at the annual meeting of the American Psychological Association, San Francisco, August 1998. Preparation of this paper was supported by Grant #MH-35856 from the National Institute of Mental Health.
Canter Kihlstrom, L. (1998). Mental health services research. In H. Friedman (Ed.), Encyclopedia of mental health (Vol. 2, pp. 653-663). San Diego, Ca.: Academic.
Kihlstrom, J.F., & Canter Kihlstrom, L. (1998, August). The living material of the field. Paper presented at the miniconvention, "Training Psychologists in the 21st Century", American Psychological Association, San Francisco.
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