澳大利亚心理健康服务中消费者的意见(英语版)

WHAT'SINASERVICE?CONSUMERS'VIEWSOFAUSTRALIANMENTALHEALTHSERVICESThispaperreportsonaseriesofinterviewswithconsumersofmentalhealthservices,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,sheidentifiestheparametersofthisstyleofresearchasresearchconductedbyandwithconsumersasopposedtoresearchconductedonbehalfofconsumers(1997:p.48),notingthisdistinctionrelatestowhocontrolstheresearchprocess.ConductingtheCEO-MHSprojectisateamofacademicandconsumerresearchers(CRs).Inapracticalsense,ourassertionthatthiscouldbedescribedasconsumerhealthresearch,webelieve,issupportedbytheworkreportedhere,asCRsfromtheteamplayedinstrumentalrolesintheinterviews,fromthestageofdevelopingtheinterviewguide,throughdatacollection,toanalyzingtranscriptsandinterpretingthemes.Ouraiminconductingtheinterviewswastoaddressthequestions:•Whataretheexperiencesofbeingaconsumerofpublicmentalhealthservices?•Whataretheimportantaspectsofamentalhealthserviceforconsumers?Weconsidertheseimportantquestionstoaskgenerally,andadditionally,asnecessarytoouroverallaimofdevelopingaconsumerdirectedevaluationmethodformentalhealthservices.MethodConsumerResearchers(CRs),workingaspartoftheCEO-MHSteam,conductedtheinterviews,whichweretranscribed.Theirrolewastoguideparticipantsthroughthesemi-structuredinterview,posingthequestionswehaddevisedandkeepingthediscussionontopic.AnexplicitaspectoftheinterviewswasforCRstoconveyasenseofempathy,allowingtheparticipantstofeeltheirvoicewasbeingheard.CRshadattendedseveraltrainingsessionsinconductinginterviewsaspartoftheiremploymentontheCEO-MHSproject(McLeod&Oades,2001).Supportwasavailableinavarietyofformsforinterviewers,andwasexplicitlyviewedastheresponsibilityoftheentireresearchteam.Additionally,supervisionwasprovidedbythefirstauthor,whichinvolvedjointreflectionwithCRsontheirskillsasinterviewers.ParticipantsAtotalof33mentalhealthconsumersparticipatedininterviews,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.TheInterviewGuideOurinterviewquestionsweredevelopedbasedinpartaroundthemesthathademergedfromfocusgroupdiscussionsourteamheldwithmentalhealthconsumerspreviously(Malins,Oades&Viney,2003).TwogroupsofCRsfromtheteamindependentlydraftedaproposalfortheinterviewquestions,usingthethemesfromthefocusgroups.Aseriesofmeetingsdiscussingthetwoproposalswerethenheld,withCRandacademicmembersoftheteamrefiningandstructuringthefinalinterviewquestions.Theresultinginterviewguideco