What future for research in mental health nursing?

This paper argues that mental health nursing research is in a poor condition. We believe that it has marginalized itself, and has effectively split itself off from developments such as evidence-based practice (Cochrane Collaboration). We will examine some of the reasons behind the current position. We will argue that there is a history of research largely conducted on nurses and the nature of nursing. Much of this work uses methods that are completely unacceptable to any conventional research discipline. Many published ‘research’ studies amount to no more than anecdotal accounts of nurses and patients’ experiences. Modern mental health services have complex problems that demand skilfully designed studies, executed with rigour and utilizing batteries of valid and reliable outcome measures. However, we firmly believe that several remedial actions could transform the current situation. The first problem is that there is little more than a vestige of an infrastructure of mental health nursing researchers with adequate training. There are probably only a few dozen with doctoral qualifications and fewer still have any substantial research training or experience. When one scrutinizes PhD theses written by psychiatric nurses, many are based on qualitative and uncontrolled studies. To compound the problem there appears to be a considerable variation in pass standards for PhDs between universities, and some theses contain fundamental flaws of design, analysis and write up. Other professions consider a well-controlled study for a PhD as a starting point in research training. For example, many psychologists and psychiatrists have received research training at a post-doctoral level and have managed large grant-funded projects before taking senior academic positions. Sadly, there are professors of nursing (including those from a mental health background) who have no substantial portfolio of decent peer-reviewed publications, let alone the experience of managing grants for large experimentally based projects. A priority is to establish an infrastructure of properly trained researchers. On a positive note opportunities for research training do exist. For example, the Medical Research Council and the NHS R and D Directorate have specifically recognized the need to train nurses for research. Other similar funds exist and are available to train for both doctoral and post-doctoral levels. However, the application rates from suitably qualified persons of a nursing background are low. The second problem concerns the way in which (we) mental health nurses organize ourselves as research teams. Many mental health nurses seem to eschew the idea of working with a multidisciplinary team of researchers, although there is a rhetoric of multidisciplinarity and teamwork. Mental health topics demand input from various perspectives. It is essential to group together not only psychiatrists, psychologists and nurses, but also pharmacists, statisticians and health economists. Statisticians are often overlooked when research grant applications are made, and, now that concepts such as statistical power need to be addressed in detail before a grant application is seriously considered, any team that omits the input of expert statistical advice does so at its peril. Health economists are also invaluable members of the research team as most health services research now has an economic dimension. This domain cannot be overlooked and a proposal for an economic analysis is now essential if a large research grant application is to succeed. The Research Assessment Exercise exposed the poor quality of nursing research, while at the same time showing that multidisciplinary teams reap rich rewards. For example, the Institute of Psychiatry gained a five-star (the very highest) rating by grouping all disciplines, including nursing, within nine specific research interest groups. Similarly the last Department of Health Research funding round (the Mental Health Initiative) awarded all of the major