澳大利亚心理健康服务中消费者的意见英语版.docx
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澳大利亚心理健康服务中消费者的意见英语版.docx
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澳大利亚心理健康服务中消费者的意见英语版
WHAT'SINASERVICE?
CONSUMERS'VIEWSOFAUSTRALIANMENTALHEALTHSERVICES
Thispaperreportsonaseriesofinterviewswithconsumersofmentalhealthservices,conductedaspartoftheConsumerEvaluationofMentalHealthServicesproject(CEO-MHS).Withoneofouroverarchingaimsbeingtodevelopaconsumerorientedandconsumerdirectedmethodofevaluatingmentalhealthservices,weconsideredseekingconsumers'viewsofmentalhealthservices,usingqualitativeinterviews,tobeessential.ConsumerResearchersfromtheteamconducted33interviewsinNSW,Australia.Eleventhemesemergedfromanalysisoftheinterviewdataandthesethemesaredescribedindetail.
ConsumerparticipationintheevaluationofservicesisincludedwithintheNationalStandardsforMentalHealthServicesinAustralia,andinternationallysimilarrecommendationsaremadeforinclusionofconsumersinserviceplanningandevaluation(CommonwealthofAustralia,1997;DepartmentofHealth,London,1999;USDepartmentofHealthandHumanServices,2001).Traditionally,methodsofevaluatingmentalhealthserviceshavebeendrivenbyprofessionals'perspectives(Campbell,1997;Prince&Prince,2001)despitemarkeddifferencesnotedbetweentheseandconsumers'constructsaboutwhatisdesirableand/oreffective(Gill,Pratt,&Librera,1998;Perkins,2001).Theaimofthispaperistoreportoninterviewsconductedwithmentalhealthconsumersduringlate2002andearly2003.TheinterviewsreportedherearesituatedwithinthecontextoftheConsumerEvaluationofMentalHealthServices(CEO-MHS)project,a3-yearprojectfundedbytheAustralianResearchCouncilandlllawarraHealth,aregionalmentalhealthserviceinNSW,Australia.CEO-MHSisacollaborativeprojectwithanoverallaimtodevelopamethodofevaluationofmentalhealthservices(Strangetal.,2001)fromaconsumerperspective,andcouldbedescribedasconsumerhealthresearch.InHunt'sdiscussionofconsumerhealthresearch,sheidentifiestheparametersofthisstyleofresearchas"researchconductedbyandwithconsumers"asopposedto"researchconductedonbehalfofconsumers"(1997:
p.48),notingthisdistinctionrelatestowhocontrolstheresearchprocess.ConductingtheCEO-MHSprojectisateamofacademicandconsumerresearchers(CRs).Inapracticalsense,ourassertionthatthiscouldbedescribedasconsumerhealthresearch,webelieve,issupportedbytheworkreportedhere,asCRsfromtheteamplayedinstrumentalrolesintheinterviews,fromthestageofdevelopingtheinterviewguide,throughdatacollection,toanalyzingtranscriptsandinterpretingthemes.Ouraiminconductingtheinterviewswastoaddressthequestions:
•Whataretheexperiencesofbeingaconsumerofpublicmentalhealthservices?
•Whataretheimportantaspectsofamentalhealthserviceforconsumers?
Weconsidertheseimportantquestionstoaskgenerally,andadditionally,asnecessarytoouroverallaimofdevelopingaconsumerdirectedevaluationmethodformentalhealthservices.
Method
ConsumerResearchers(CRs),workingaspartoftheCEO-MHSteam,conductedtheinterviews,whichweretranscribed.Theirrolewastoguideparticipantsthroughthesemi-structuredinterview,posingthequestionswehaddevisedandkeepingthediscussionontopic.AnexplicitaspectoftheinterviewswasforCRstoconveyasenseofempathy,allowingtheparticipantstofeeltheirvoicewasbeingheard.CRshadattendedseveraltrainingsessionsinconductinginterviewsaspartoftheiremploymentontheCEO-MHSproject(McLeod&Oades,2001).Supportwasavailableinavarietyofformsforinterviewers,andwasexplicitlyviewedastheresponsibilityoftheentireresearchteam.Additionally,supervisionwasprovidedbythefirstauthor,whichinvolvedjointreflectionwithCRsontheirskillsasinterviewers.
Participants
Atotalof33mentalhealthconsumersparticipatedininterviews,14malesand19females,ranginginagefrom20yearsto67years.Thestudyhadreceivedapprovalfromthehumanresearchethicsboardoftheaffiliateduniversity,andeachparticipantgaveinformedconsenttotakepartintheirinterview.Weadoptedapurposivesamplingmethod,seekingmaximumvariation,inrecruitinginterviewparticipants(Patton,1990).Purposivelyselectingparticipantsrecognizesagoalofattemptingtounderstandconsistentwithouraimandanalysismethod,comparedtothegoalofgeneralizationthatismorecommontoquantitativeresearch(Maykut&Morehouse,1994).Specifically,wesampledforconsumerswhohadarangeofexperienceswithdifferentservicesettings;typeandamountofcontactwithservices;geographicalsettingofservicesused;culturalandlinguisticbackgrounds;mentalhealthliteracy;andchoiceintreatment,intermsofperceivingthemselvesasvoluntaryorinvoluntaryclientsofmentalhealthservices.Inadditiontotheseareas,wesoughttobalancegenderandensuredarangeofages.Thesesamplingareasweredeterminedthroughaseriesofteammeetingsconsideringthequestion:
•\Nhataretheimportantvariablesthatmayaffectconsumers'experiencesofpublicmentalhealthservices?
Feedbackfromexternalconsumerconsultantswasincorporatedintothediscussions.
TheInterviewGuide
Ourinterviewquestionsweredevelopedbasedinpartaroundthemesthathademergedfromfocusgroupdiscussionsourteamheldwithmentalhealthconsumerspreviously(Malins,Oades&Viney,2003).TwogroupsofCRsfromtheteamindependentlydraftedaproposalfortheinterviewquestions,usingthethemesfromthefocusgroups.Aseriesofmeetingsdiscussingthetwoproposalswerethenheld,withCRandacademicmembersoftheteamrefiningandstructuringthefinalinterviewquestions.Theresultinginterviewguideconsistedofeightquestions:
thefirsttwowerebroadopen-endedquestionsinvitingparticipantstodiscusstheirviewsofmentalhealthservicesgenerallyandtheothersixquestionsrevolvedaroundissuesidentifiedinanalysisofthefocusgroups.Giventhesemi-structurednatureoftheinterviews,eachoftheseeightquestionswasfollowedwithaseriesofpromptsthatCRsutilizedininterviewsasnecessary.
Analysis
ThefirstandlastauthorsconductedanalysesoftheinterviewtranscriptsusingtheInterpretativePhenomenologicalAnalysismethod(IPA)(Smith,Jarman&Osborn,1999).Thefirstauthorconductedanalysisusing33transcriptswhilethelastanalyzed2/3ofthetranscripts.IPAoffersacomprehensiveprocessforconductinganalysis,describedbybothSmithetal.(1999)andWillig(2001)andwaschosenasthemethodofanalysisbecauseofitsfocusonpersonalmeanings,whilecentrallyrecognizingtheinterpretativeprocessofanalysis(Smithetal.,1999).SeparateanalysesusingtheIPAmethodwereconducted,andthenmasterlistsofthemeswerecompared,asingleinclusiveinterpretationbeingdevelopedfromthetwoanalyses.
StigmaandAcceptance
Thisthemerepresentsparticipants'directdiscussionofstigmaasanissueforthem,withinmentalhealthservices,withinthecommunity,andforthemselves.Forexample,oneparticipantsays:
Ithinkthat'sthebigoneaboutthemnottreatingmelikeaperson.Asthisparticipantgoesontotellherstory,sherelaysthisexperience:
Adoctorfromoutofherestoppedmeinthemiddleofthestreetandpointedtoallhisoff-sidedoctors—traineedoctors—pulledupmysleeveand...said"lookatthisstupidgirl,cuttingherselfand...thatdevastatedme."(Participant11).
InformationandEducation
Mostcommonly,participantsdiscussedthelackofinformationtheyreceive.Thisrelatestoavarietyofareasofserviceprovision,forexamplelackofinformationaboutmedication,andabouttheirdiagnosis.Oneparticipantsaid,inrelayingastoryaboutbeingprovidedwithnewmedication:
That'sverypoor,justbeingputonanewmedication.Iwouldn'teven[have]hadthenameofitwrittendownunlessIspecificallyaskedsomeonetowriteitdownforme.Istilldon'thaveanyofthelistofside-effectsthatitcauses...ifyouwantanyinformationaboutmedicationyou'vegottospecificallyaskforit,youknowwhatImean?
Thenyouareluckytogetit!
(Participant18).Severalparticipantsrefertoseekinginformationoutsideofthesystem:
borrowingorbuyingbooks,andwatchingtelevisionprogramsandusefulvideos.Anotheraspectofthethemerelatestobeinginformed,asdistinctfromaccessinginformation,howeversimilarly,ismostfrequentlyraisedintermsofparticipants'senseofthelackofbeingkeptinformed.Beinginformedhasamorepersonalfocusthanaccesstoinformation,relatingtoconsumers'owncareandroleintheservice.Bothhavingaccesstoinformationandbeinginformedcontributetoempowermentofconsumers,asoneparticipantstatesclearly:
Theempowermentoftheconsumerisreallyimportant,Ithinkit'sreallyimportantthatthementalhealthservicesstaffgiveconsumersthefullestinformationpossibleabouttreatment,aboutdiagnosis,aboutprognosis,abouthowlongthey'relikelytobeonmedication,abouthowlongthey'relikelytobeintheservice...(Participant7).Educationofbothstaff/professionalsandcommunityalsofallwithinthistheme.Mostfrequently,participants'suggestionsofareaswhereeducationisneeded,forbothstaffandthegeneralcommunity,isinunderstandingwhatitisliketoexperienceamentalillness.Relatedtostaffeducationistheimplicationthatstaffknowledgeandexpertiseaffectsconsumers'experiences.Someparticipantsmadereferencetothelevelofexpertiseorknowledgementalhealthstaffhad.Anaspectofcommunityeducationrelatesspecificallytothatofcareersandfamilymembers,andhowservicescankeeptheminformedandeducated.Asthetheme
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- 澳大利亚 心理健康 服务 消费者 意见 英语版