Psychiatric decision making in the 90's: the coming era of decision support.

Guidelines for how mental health care is allocated form a pivotal point on the fulcrum balancing preservation of quality care and containment of costs. Advances in information system technology are creating new opportunities for research-based decision support tools in this area. Such tools can systematically and reliably scale the domains of evidence used in psychiatric assessment in order to more precisely describe the severity of impairment and point to appropriateness of care decisions. The first psychiatric decision support tools were introduced in the 1960s in response to changes in the mental health community, but research in this area tended to have limited inter-rater reliability or validity. More recently, several computerized decision support tools have been developed, with a stronger research base and consequently a wider application. These tools are reviewed, and one such tool is described in greater depth to illustrate the possibilities of computer technology and the direction in which decision support software is headed.