The term 'evaluation' is both widely and imprecisely used. This is particularly true when evaluation is applied to health services rather than to specific treatments. Therefore our first task in discussing the evaluation of psychiatric services is to define terms. In this chapter we shall go on to consider why psychiatric services should be evaluated, particularly because clarification of the purpose of a particular evaluation is likely to bring subsequent decisions about research design into sharper focus. Next, we address the question of what needs to be evaluated, at the different levels of the psychiatric service, to produce information relevant for planners as well as for practitioners and patients. We then discuss how to evaluate psychiatric services, both in terms of the scales and instruments that may be useful and the available research designs. In particular, we shall illustrate the range of designs with examples from one key domain of recent outstanding psychiatric research, namely the evidence about assertive community-based care for those with severe mental illness. Finally, we conclude by discussing the key challenges of psychiatric service evaluation and their implications for future research and clinical practice.

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