Introduction

The last part of the meeting was devoted to a discussion about ideas for new research. The following chapter is an edited version of these contributions. The session was introduced by Professor Tom Craig who sought answers to two important questions that recurred frequently throughout the meeting; the choice of research design and the identification of the special ingredients that made for successful community care. The third issue that received considerable attention was that of training of staff in community psychiatry and the importance of research in evaluating this.

The randomised controlled trial

Many of the limitations of the randomised controlled trial were pointed out by the delegates. Such trials are ideal for comparing specific treatments, such as drugs, where a patient clearly receives one drug or the other. Service utilisation cannot be separated in the same way, although the methodology of the randomised controlled trial tends to force a Procrustean separation. Dr Burns felt that we were too preoccupied in separating hospital and non-hospital treatment. He argued that we were really comparing different ways of delivering services, both of which involved hospital treatment; in very few cases would no hospital treatment be used. The results of the studies described at the meeting (and abroad) showed that with good community care the degree of hospitalisation was reduced for a substantial number of patients. By reducing the overall need of most patients for hospital care important gains were achieved. This did not however mean that hospital care was inappropriate and it would be wrong to interpret the results in this way.