Mental health articles

OF mental health care and mentally ill

Literature on psychiatric patient satisfaction and dissatisfaction

The emerging body of satisfaction research about mental health services has commonly adopted a needs-assessment approach. This has usually assessed patient satisfaction according to ‘normative need’; that is need defined by an acknowledged expert and typically ascertained by means of standardized assessment tools. These approaches have been linked to the emphasis on ‘quality assurance’, which is a type of evaluation research which is concerned with patient satisfaction.

According to the WHO, the aim of quality assurance is: ‘… to assure that each patient receives such a mix of diagnostic and therapeutic health services as is most likely to produce the optimal achievable health care outcome for that patient’. This form of evaluation of ‘client need’ focuses on the narrow measurement of the behaviour of the mental health client. Unlike the view of patients defined by psychopathology, this approach treats people as complete individuals in the sense that understanding is based on the everyday actions and language of individuals. However, this approach is still defined professionally, as this account of the observations of one quality assurance programme suggests:

Once out of the client’s hearing, however, the results of these inter-actions are often re-analysed in terms of a specific (and professionalised) linguistic framework. Thus, a game of ten-pin bowling is re-analysed in terms of ‘motor skills’. A discussion about food is re-analysed in terms of coping skills. A lapse of memory is discussed in terms of a syndrome and a leisure time activity is analysed in terms of affective disorder. In fact client ‘problems’ are in many respects newly created through the application of behaviourist discourse to what are called ‘activities of daily living’. (Prior 1991: 141–2)

In addition to this behaviourist approach, there is a small amount of research conducted from within statutory services which does not presume that mental health services are only there to do people good. Rather than ‘normative need’ this research has focused on ‘felt need’ (Bradshaw 1972). An early example of this was Mayer and Timms’s (1970) work in which social workers were encouraged to take seriously the views expressed by clients. The work of Beresford and Croft (1986) also highlights the views of users of social services and emphasizes the need for genuine participation by users in research about services.

While professionally defined needs tend to focus on behaviour and the effectiveness of prescribed treatments, the ‘felt need’ evaluations tend to emphasize the material and social aspects of people’s everyday lives. Kay and Legg (1986) found that the need to have a job was a high priority for those recently discharged from hospital. An example is a survey which examined the expressed needs of patients vis-à-vis their living arrangements and material and social support (Hatfield, Huxley and Hadi 1992). A sizeable minority of patients expressed dissatisfaction with their living arrangements. Those living in staffed accommodation were particularly critical and did not view their living situations as a result of their own positive choice. The survey also identified a ‘substantial level of felt need for work’.Users of mental health services 225

A more recent survey of discharged patients revealed a number of aspects about their quality of life in the community. These included their sense of vulnerability, the benefits of community care, an appreciation of the support of others, an awareness of the impact of scarce resources and disappointment about poor coordination between health and social services.

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