Mental Illness and Serious Harm to Others - University of Liverpool

NHS National Programme on Forensic Mental Health Research and Development
6. Effective Commissioning of Research
Research in this area is necessarily complex. In many instances (and at least two of the
three areas outlined in Section 5), it will depend on availability of clinical time over and
above standard practice, and will be researcher intensive in identifying cases and
maintaining the follow-up. It is important that there are resources adequate to the task -
in terms of both funding and expertise. To date neither have been adequate in quantity.
Forensic mental health is a relatively new discipline, with a demand for people who are
particularly likely to have strengths in service development, preparing reports for courts
and official bodies, and providing services; many are not naturally inclined to clinical
science as well. Some development has been possible under the Baxter Fellowship
Scheme, sponsored by the National Programme on Forensic Mental Health R&D. Also,
before the University Research Assessment Exercise, the appointment of clinical lecturers
was another route to training academics with relevant experience. A subsequent career
structure, particularly for the disciplines outside medicine, is still lacking. It is essential
that more is done to foster this if good researchers are to be drawn into the field and
retained. Achieving such representation will, coincidentally, improve the attraction and
retention of high-calibre clinicians (Knesper, 1978).
Reiss and Roth (1993/4) highlighted a shortfall in government and other agency
commitment to funding research in this area in the USA. Research expenditure per year
of life lost for selected causes of death in the fiscal year 1989 were $441 for heart / lung /
blood diseases, $697 for AIDS, $794 for cancer, but just $31 for violence. They might have
added that there is no apparent shortage of funding for prisons. In California, for
example, about 10 per cent of the state budget is spent on imprisonment. The situation is
not so obviously different in the UK. The National Programme on Forensic Mental Health
R&D has been effective in raising the profile of this field as important for research, but
still appears to have a budget which is far too small and relatively little compensatory
influence in real terms on other sources of money.
In the wake of Health Service perceptions of civil rights and duties of confidentiality (NHS
Executive, 1999), longitudinal research with people who have been patients is increasingly
difficult. Problems of tracing and engaging people for the longer term exist, but pale by
the side of those engendered by a beneficent but paternalistic and sometimes obstructive
system which many health and allied services adopt if asked for assistance with tracing.
Ways of slimming the bureaucracy without jeopardising patients' safety and rights are
needed. Improved ways of communicating with service users and prospective service users
about the value of their co-operation in such research are also needed.
Perhaps the most difficult step for any research is moving towards its application in
practice. Clinicians are often slow to respond, but in this area there are perceptions that
wider policy is insufficiently evidence-based. The shift to increasing custodial care for
those with and without mental disorder alike is widely perceived as one such area. It
seems likely that policy makers who not only embrace principles of evidence0based
practice but are also seen to adopt them in policy making are likely to provide a better
framework for research and development.
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