澳大利亚心理健康服务中消费者的意见(英语版).doc

澳大利亚心理健康服务中消费者的意见(英语版).doc

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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.Inadditiontothes