Side effects of psychiatric treatment: a qualitative study of issues associated with a random allocation research study

A random allocation study of the effectiveness of day hospital treatment for acute psychiatric illness was carried out in two district general hospitals. During the study it became apparent that in one hospital numerous patients being randomised to the day hospital failed to become established in treatment. In depth interviews were carried out with the day hospital staff in an attempt to elicit the reasons for this. It became clear that staff perceptions of the role of the day hospital is a potential source of bias in this type of study. A case study of one patient who was transferred from day to inpatient treatment during the study illustrates the dynamics of this bias. The paper demonstrates, once again, the value of concurrent qualitative research while performing a randomised controlled trial. In this particular case the qualitative interview indicates the reasons why the results of randomised controlled trials at one centre cannot necessarily be generalised to other centres.