1、澳大利亚心理健康服务中消费者的意见英语版WHATS IN A SERVICE? CONSUMERS VIEWS OF AUSTRALIAN MENTAL HEALTH SERVICESThis paper reports on a series of interviews with consumers of mental health services, conducted as part of the Consumer Evaluation of Mental Health Services project (CEO-MHS). With one of our overarching aim
2、s being to develop a consumer oriented and consumer directed method of evaluating mental health services, we considered seeking consumers views of mental health services, using qualitative interviews, to be essential. Consumer Researchers from the team conducted 33 interviews in NSW, Australia. Elev
3、en themes emerged from analysis of the interview data and these themes are described in detail.Consumer participation in the evaluation of services is included within the National Standards for Mental Health Services in Australia, and internationally similar recommendations are made for inclusion of
4、 consumers in service planning and evaluation (Commonwealth of Australia, 1997; Department of Health, London, 1999; US Department of Health and Human Services, 2001). Traditionally, methods of evaluating mental health services have been driven by professionals perspectives (Campbell, 1997; Prince &
5、Prince, 2001) despite marked differences noted between these and consumers constructs about what is desirable and/or effective (Gill, Pratt, & Librera, 1998; Perkins, 2001). The aim of this paper is to report on interviews conducted with mental health consumers during late 2002 and early 2003. The i
6、nterviews reported here are situated within the context of the Consumer Evaluation of Mental Health Services (CEO-MHS) project, a 3-year project funded by the Australian Research Council and lllawarra Health, a regional mental health service in NSW, Australia. CEO-MHS is a collaborative project with
7、 an overall aim to develop a method of evaluation of mental health services (Strang et al., 2001) from a consumer perspective, and could be described as consumer health research. In Hunts discussion of consumer health research, she identifies the parameters of this style of research as research cond
8、ucted by and with consumers as opposed to research conducted on behalf of consumers (1997: p. 48), noting this distinction relates to who controls the research process. Conducting the CEO-MHS project is a team of academic and consumer researchers (CRs). In a practical sense, our assertion that this
9、could be described as consumer health research, we believe, is supported by the work reported here, as CRs from the team played instrumental roles in the interviews, from the stage of developing the interview guide, through data collection, to analyzing transcripts and interpreting themes. Our aim i
10、n conducting the interviews was to address the questions: What are the experiences of being a consumer of public mental health services? What are the important aspects of a mental health service for consumers? We consider these important questions to ask generally, and additionally, as necessary to
11、our overall aim of developing a consumer directed evaluation method for mental health services. MethodConsumer Researchers (CRs), working as part of the CEO-MHS team, conducted the interviews, which were transcribed. Their role was to guide participants through the semi-structured interview, posing
12、the questions we had devised and keeping the discussion on topic. An explicit aspect of the interviews was for CRs to convey a sense of empathy, allowing the participants to feel their voice was being heard. CRs had attended several training sessions in conducting interviews as part of their employm
13、ent on the CEO-MHS project (McLeod & Oades, 2001). Support was available in a variety of forms for interviewers, and was explicitly viewed as the responsibility of the entire research team. Additionally, supervision was provided by the first author, which involved joint reflection with CRs on their
14、skills as interviewers.ParticipantsA total of 33 mental health consumers participated in interviews, 14 males and 19 females, ranging in age from 20 years to 67 years. The study had received approval from the human research ethics board of the affiliated university, and each participant gave informe
15、d consent to take part in their interview. We adopted a purposive sampling method, seeking maximum variation, in recruiting interview participants (Patton, 1990). Purposively selecting participants recognizes a goal of attempting to understand consistent with our aim and analysis method, compared to
16、 the goal of generalization that is more common to quantitative research (Maykut & Morehouse, 1994). Specifically, we sampled for consumers who had a range of experiences with different service settings; type and amount of contact with services; geographical setting of services used; cultural and li
17、nguistic backgrounds; mental health literacy; and choice in treatment, in terms of perceiving themselves as voluntary or involuntary clients of mental health services. In addition to these areas, we sought to balance gender and ensured a range of ages. These sampling areas were determined through a
18、series of team meetings considering the question: Nhat are the important variables that may affect consumers experiences of public mental health services? Feedback from external consumer consultants was incorporated into the discussions.The Interview GuideOur interview questions were developed based
19、 in part around themes that had emerged from focus group discussions our team held with mental health consumers previously (Malins, Oades & Viney, 2003). Two groups of CRs from the team independently drafted a proposal for the interview questions, using the themes from the focus groups. A series of
20、meetings discussing the two proposals were then held, with CR and academic members of the team refining and structuring the final interview questions. The resulting interview guide consisted of eight questions: the first two were broad open-ended questions inviting participants to discuss their view
21、s of mental health services generally and the other six questions revolved around issues identified in analysis of the focus groups. Given the semi-structured nature of the interviews, each of these eight questions was followed with a series of prompts that CRs utilized in interviews as necessary.An
22、alysisThe first and last authors conducted analyses of the interview transcripts using the Interpretative Phenomenological Analysis method (IPA) (Smith, Jarman & Osborn, 1999). The first author conducted analysis using 33 transcripts while the last analyzed 2/3 of the transcripts. IPA offers a compr
23、ehensive process for conducting analysis, described by both Smith et al. (1999) and Willig (2001) and was chosen as the method of analysis because of its focus on personal meanings, while centrally recognizing the interpretative process of analysis (Smith etal., 1999). Separate analyses using the IP
24、A method were conducted, and then master lists of themes were compared, a single inclusive interpretation being developed from the two analyses.Stigma and AcceptanceThis theme represents participants direct discussion of stigma as an issue for them, within mental health services, within the communit
25、y, and for themselves. For example, one participant says: I think thats the big one about them not treating me like a person. As this participant goes on to tell her story, she relays this experience: A doctor from out of here stopped me in the middle of the street and pointed to all his off-side do
26、ctorstrainee doctors pulled up my sleeve and.said look at this stupid girl, cutting herself and.that devastated me. (Participant 11).Information and EducationMost commonly, participants discussed the lack of information they receive. This relates to a variety of areas of service provision, for examp
27、le lack of information about medication, and about their diagnosis. One participant said, in relaying a story about being provided with new medication: Thats very poor, just being put on a new medication. I wouldnt even have had the name of it written down unless I specifically asked someone to writ
28、e it down for me. I still dont have any of the list of side-effects that it causes.if you want any information about medication youve got to specifically ask for it, you know what I mean? Then you are lucky to get it! (Participant 18). Several participants refer to seeking information outside of the
29、 system: borrowing or buying books, and watching television programs and useful videos. Another aspect of the theme relates to being informed, as distinct from accessing information, however similarly, is most frequently raised in terms of participants sense of the lack of being kept informed. Being
30、 informed has a more personal focus than access to information, relating to consumers own care and role in the service. Both having access to information and being informed contribute to empowerment of consumers, as one participant states clearly: The empowerment ofthe consumer is really important,
31、I think its really important that the mental health services staff give consumers the fullest information possible about treatment, about diagnosis, about prognosis, about how long theyre likely to be on medication, about how long theyre likely to be in the service. (Participant 7). Education of bot
32、h staff/professionals and community also fall within this theme. Most frequently, participants suggestions of areas where education is needed, for both staff and the general community, is in understanding what it is like to experience a mental illness. Related to staff education is the implication t
33、hat staff knowledge and expertise affects consumers experiences. Some participants made reference to the level of expertise or knowledge mental health staff had. An aspect of community education relates specifically to that of careers and family members, and how services can keep them informed and educated. As the theme
