Researching the mental health needs of hard-to-reach groups: managing multiple sources of evidence

Background: common mental health problems impose substantial challenges to patients, carers, and health care systems. A range of interventions have demonstrable efficacy in improving the lives of people experiencing such problems. However many people are disadvantaged, either because they are unable to access primary care, or because access does not lead to adequate help. New methods are needed to understand the problems of access and generate solutions. In this paper we describe our methodological approach to managing multiple and diverse sources of evidence, within a research programme to increase equity of access to high quality mental health services in primary care.Methods: we began with a scoping review to identify the range and extent of relevant published material, and establish key concepts related to access. We then devised a strategy to collect - in parallel - evidence from six separate sources: a systematic review of published quantitative data on access-related studies; a meta-synthesis of published qualitative data on patient perspectives; dialogues with local stakeholders; a review of grey literature from statutory and voluntary service providers; secondary analysis of patient transcripts from previous qualitative studies; and primary data from interviews with service users and carers.We synthesised the findings from these diverse sources, made judgements on key emerging issues in relation to needs and services, and proposed a range of potential interventions. These proposals were debated and refined using iterative electronic and focus group consultation procedures involving international experts, local stakeholders and service users.Conclusions: our methods break new ground by generating and synthesising multiple sources of evidence, connecting scientific understanding with the perspectives of users, in order to develop innovative ways to meet the mental health needs of under-served group

Police performance measurement: an annotated bibliography

This study provides information to assist those involved in performance measurement in police organisations. The strategies used to identify the literature are described. Thematic sections cover; general overviews; methodological issues; performance management in other industries; national, international and cross-national studies; frameworks (e.g. Compstat; the Balanced Scorecard); criticisms (particularly unintended consequences); crime-specific measures; practitioner guides; performance evaluation of individual staff; police department plans and evaluations; annotated bibliographies in related areas, and; other literature. Our discussion offers two conclusions: the measures best aligned with performance are typically more expensive, while most operational data should only provide contextual information; the philosophy of open governance should be pursued to promote transparency, accountability and communication to improve police performance

Improving Access to Mental Health Care in an Orthodox Jewish Community: A Critical Reflection Upon the Accommodation of Otherness

The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England

Messing Up Texas?: A Re-Analysis of the Effects of Executions on Homicides

<div><p>Executions in Texas from 1994–2005 do not deter homicides, contrary to the results of Land et al. (2009). We find that using different models—based on pre-tests for unit roots that correct for earlier model misspecifications—one cannot reject the null hypothesis that executions do not lead to a change in homicides in Texas over this period. Using additional control variables, we show that variables such as the number of prisoners in Texas may drive the main drop in homicides over this period. Such conclusions however are highly sensitive to model specification decisions, calling into question the assumptions about fixed parameters and constant structural relationships. This means that using dynamic regressions to account for policy changes that may affect homicides need to be done with significant care and attention.</p></div

ARIMA transfer function models of Monthly Texas Homicides with additional covariates, 1994–2005.

<p>Standard errors in parentheses.</p

Changepoint model for monthly Texas homicides with covariates, 1986(3)–2009(8).

<p>First entry is the coefficient, second in parentheses are the standard errors, followed by the two-sided p-values.</p

Count of Post-Gregg executions by state as of 2009.

<p>Count of Post-Gregg executions by state as of 2009.</p