Background Arguments for and againstevidence-basedpsychiatryhave mostlycentred on its value for clinical practice

Declaration of interest None. In the ongoing debate over evidence-based psychiatry, most of the arguments pro and contra have centred around the relevance of this strategy for clinical practice and teaching. In Britain, however, analogous concepts are now being applied to service planning, as part of the government initiative to move health care from a system founded in clinical knowledge and authority to one based on systematic research (Higgit & Fonagy, 2002). Thus, the National Service Framework for Mental Health (Department of Health, 1999) draws on a ‘synthesis of evidence’ from research findings, rated on a five-point ordinal scale according to their inferential power (see Appendix). A closer scrutiny of the evidence in question seems due, and should comprehend clinical trial results as well as service evaluations, since the former are now being used increasingly to control population access to new forms of treatment via the National Health Service (NHS) approval and purchasing systems (McKee & Clarke, 1995). The aims of this review are fourfold: first, to outline the development of the ‘evidence-based’ project; second, to summarise growing clinical and social criticism of this approach; third, to examine the research evidence on which British mental health policy currently relies; and finally, to consider how this evidence base might in future be improved, in terms of balance and coverage. To achieve these aims the following sources were monitored: