An overview of patient satisfaction with psychiatric treatment

Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental health services as well as treatment compliance and treatment outcome. Although assessment of patient satisfaction is crucial to designing effective mental health programs, no standard methodology exists to measure satisfaction; thus it is difficult to compare findings from different satisfaction studies. The author examines the studies in four areas of satisfaction research: patient satisfaction with treatment, with participation in research, with participation as subjects in psychiatric teaching, and with involuntary commitment. He notes the variance between mental health professionals' expectations of patient satisfaction and the higher satisfaction that patients themselves report. He also discusses the need for more study of the subjective experience of patients who participate in research projects, teaching conferences, and observed psychotherapy and who undergo involuntary commitment.     

Severely Mentally Ill Patients with and Without Substance Use Disorders: Characteristics Associated with Treatment Attrition

We aimed to describe characteristics associated with attrition for patients in community mental health treatment with chronic mental illness with and without substance use disorders. Baseline assessments included symptom severity, treatment satisfaction, social support, and a structured diagnostic interview. Treatment attrition was assessed at six months. At six months, 36% of the dual diagnosis group (n = 25), and 61% of the mental illness alone group (n = 23) were lost to follow-up. Attrition in the dually diagnosed group tended to be associated with less satisfaction with treatment, and higher mean symptom scores. There were no characteristics associated with attrition in the group of patients with mental illness alone. However, client satisfaction tended to increase among the mental illness alone patients that were successfully followed. The dually diagnosed group that remained in treatment had a significantly lower mean treatment satisfaction score than the mental illness alone group at six months. This type of investigation should aid in patient care and evaluation of treatment programs for persons with severe mental illness and co-occurring substance use disorders.     

Integrated care in schizophrenia: a 2-year randomized controlled study of two community-based treatment programs

OBJECTIVE: To evaluate the efficacy of two community-based programs that combined antipsychotic medication, family interventions and social skills training. METHOD: A randomized controlled trial with 2 years follow-up. The study included 84 patients with schizophrenic disorders, continuously managed in terms of care and treatment, and regularly assessed. Analysis was by intention-to-treat. RESULTS: Between-program comparisons showed significantly improved social function and consumer satisfaction in favour of the program 'Integrated Care' (IC) at the 2-year follow-up. The main clinically important differences between the two treatment programs studied were the procedures for shared decision making and patient empowerment in IC. CONCLUSION: The implementation of IC in clinical practice can improve social recovery and increase consumer satisfaction for patients with schizophrenic disorders. We identified specific procedures that might be added to improve the effectiveness of any program for severely mental ill people.     

Recent Advances in Delivering Mental Health Treatment via Video to Home

Purpose of Review

Telemental health has rapidly evolved as technology and policy advances have allowed new and innovative approaches, including the remote delivery of services directly to patients’ homes. This review examined the literature on video to home (VTH) delivery of mental health services to synthesize information regarding (1) the comparative clinical effectiveness of VTH to in-person mental health treatment, (2) impact of VTH on treatment adherence, (3) patient and provider satisfaction with VTH, (4) cost effectiveness of VTH, and (5) clinical considerations for VTH use.

Recent Findings

Clinical effectiveness, treatment adherence, and patient satisfaction outcomes are comparable for VTH and in-person delivery of psychotherapy and psychiatric consultation services. Clinical applications for VTH have expanded in an effort to provide mental health care to difficult to reach, underserved populations. VTH is less costly than in-person care when assuming that patients could employ existing personal technologies.

Summary

VTH delivery offers a safe and effective option for increasing access to mental health care for patients who face logistical and stigma-related barriers to receiving in-person treatment. VTH should be routinely offered to patients as an option for receiving care, maximizing patient choice, and coordination of care.

     

Measuring treatment outcome and client satisfaction among children and families

As the delivery and reimbursement methods for mental health services change rapidly, measuring treatment outcome and client satisfaction has become critical. This article describes a case example of a treatment outcome and client satisfaction assessment program at the Children's Health Council, a private nonprofit agency affiliated with Stanford University that provides comprehensive mental health services to children and families in Palo Alto, California. Approximately 300 families receive mental health treatment per year at the agency. The simple and inexpensive program presented herein can be used and modified by other mental health professionals and agencies struggling to develop satisfactory treatment outcome and client satisfaction evaluation programs.     

Relationship of youth satisfaction with mental health services and changes in symptoms and functioning

This study examined how youth-reported satisfaction with specialty mental health services was associated with youths' symptom and functioning change. Change in clinical functioning was assessed prospectively on the basis of parent, youth, and interviewer report for 369 youths (aged nine to 18 years at study entry) receiving mental health services. Satisfaction was assessed at two-year follow-up. The results indicated that satisfaction was only minimally associated with clinical change, and only in the case of youth-reported clinical change. Parent- and interviewer-reported change were not associated with consumer satisfaction. These results suggest that consumer satisfaction is not a good indicator of effectiveness of treatment in changing clinical functioning.     

Mental illness as a predictor of satisfaction with inpatient care at Veterans Affairs hospitals.

OBJECTIVE: Patient satisfaction ratings are increasingly being used as an indicator of quality of care. However, satisfaction scores do not account for differences in satisfaction among patients that may be attributable to sociodemographic characteristics or type of illness rather than to the quality of service delivery. This study examines the role of psychiatric diagnosis in satisfaction with inpatient care delivered at Department of Veterans Affairs (VA) hospitals. METHODS: Data were taken from a large national VA customer feedback survey of patients discharged from VA hospitals between June 1 and August 31, 1995 (N=38,789). Analyses examined whether patients discharged with a psychiatric diagnosis were less satisfied with care than those discharged with a nonpsychiatric diagnosis. RESULTS: Patients with a psychiatric diagnosis were less satisfied with their care, regardless of whether they were treated in a psychiatric treatment program or a medical unit, and this relationship remained after the analysis adjusted for other determinants of satisfaction. The association between low satisfaction and psychiatric diagnosis was more pronounced among nonblack patients. CONCLUSIONS: The results suggest the need for caution in using patient satisfaction measures to compare mental health programs and other health care programs.     

A meta-analysis of the effectiveness of mental health case management over 20 years

OBJECTIVE: Meta-analytical methods were used to investigate the effectiveness of case management and to compare outcomes for assertive community treatment and clinical case management. METHODS: Controlled studies of case management published between 1980 and 1998 were identified from reviews and through database searches. The results were quantitatively combined and compared with results of studies of mental health services without case management. Combined effect sizes and significance levels for 12 outcome domains were calculated. Analysis of homogeneity was used to explore differences between models. RESULTS: Forty-four studies were analyzed; 35 compared assertive community treatment or clinical case management with usual treatment, and nine directly compared assertive community treatment with clinical case management. Both types of case management were more effective than usual treatment in three outcome domains: family burden, family satisfaction with services, and cost of care. The total number of admissions and the proportion of clients hospitalized were reduced in assertive community treatment programs and increased in clinical case management programs. In both programs the number of hospital days used was reduced, but assertive community treatment was significantly more effective. Although clients in clinical case management had more admissions than those in usual treatment, the admissions were shorter, which reduced the total number of hospital days. The two types of case management were equally effective in reducing symptoms, increasing clients' contacts with services, reducing dropout rates, improving social functioning, and increasing clients' satisfaction. CONCLUSIONS: Both types of case management led to small to moderate improvements in the effectiveness of mental health services. Assertive community treatment had some demonstrable advantages over clinical case management in reducing hospitalization.     

What do psychiatric emergency patients really want and how do they feel about what they get?

Psychiatric emergency patients range along a continuum from persons who present to the service with specific requests for help, to individuals who are brought to the service in handcuffs against their will for reasons they do not understand. In addition, studies suggest that psychiatric emergency patients' wishes and expectations often fall outside the traditional framework of psychiatric assessment (1), are not straightforward or concrete (2) or are not accurately perceived by the clinicians who see them (3). How these factors impact on patient satisfaction with the treatment they have received is not well-understood, because the manner in which specific patient variables and treatments might relate to patient satisfaction among the psychiatric emergency service population has not been systematically studied (4) (5) (6). In contrast, psychiatric inpatients and outpatients (7) (8) (9) usually express positive attitudes about their mental health care, although this finding may be skewed by a lack of real anonymity (10). Chronic patients tend to express less satisfaction with their treatment programs than do others, and patient satisfaction in some studies has been related to patient demographics, diagnoses, treatment histories (11) and patients' global rating of treatment outcome (12).     

Adaptation of Intensive Mental Health Intensive Case Management to Rural Communities in the Veterans Health Administration

There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.     

Satisfaction with primary and specialized mental health care among patients with mental disorders

The purpose of this article is to assess the satisfaction of patients who received primary or specialized mental health care, and to identify variables associated with each level of care. This cross-sectional study included 325 patients with mental disorders (MDs). We used a conceptual framework based on Andersen’s behavioral model, comprising predisposing factors, enabling factors, and needs; socio-demographic, clinical, needs-related, service-use, and quality-of-life variables were integrated into the model. We performed adjusted multiple linear regression models. The mean score on patient satisfaction for primary and specialized care was approximately 4 (range: 3.67–5.0). Regarding enabling factors, better continuity of care and having a case manager were associated with patient satisfaction for both types of care; help received from services and relatives was positively associated with patient satisfaction in primary care, whereas patients on welfare were more likely to be dissatisfied with specialized care. Number of needs was negatively associated with patient satisfaction in primary care and, marginally so, in specialized care. Suicidal ideation was marginally associated with patient dissatisfaction for specialized care only.

Results revealed a high level of patient satisfaction with each type of care, with significant variables related to continuity of care, case management, and needs. The study suggests the critical importance of addressing patient needs comprehensively, and of establishing long-term, individual recovery plans that promote patient satisfaction. Collaboration between relatives of patients and professionals in patient treatment is closely related to satisfaction with primary care. Accounting for the presence of suicidal ideation and patient vulnerability is fundamental to increasing patient satisfaction with specialized care. Increased patient follow-up in the community, work integration, provision of supported housing, and rapid crisis intervention may help improve patient satisfaction with mental health service (MHS) while supporting recovery.     

The Organizational Social Context of Mental Health Medicaid Waiver Programs with Family Support Services: Implications for Research and Practice

Peer family support specialists (FSS) are parents with practical experience in navigating children’s mental health care systems who provide support, advocacy, and guidance to the families of children who need mental health services. Their experience and training differ from those of formally trained mental health clinicians, creating potential conflicts in priorities and values between FSS and clinicians. We hypothesized that these differences could negatively affect the organizational cultures and climates of mental health clinics that employ both FSS and mental health clinicians, and lower the job satisfaction and organizational commitment of FSS. The Organizational Social Context measure was administered on site to 209 FSS and clinicians in 21 mental health programs in New York State. The study compared the organizational-level culture and climate profiles of mental health clinics that employ both FSS and formally trained clinicians to national norms for child mental health clinics, assessed individual-level job satisfaction and organizational commitment as a function of job (FSS vs. clinician) and other individual-level and organizational-level characteristics, and tested whether FSS and clinicians job attitudes were differentially associated with organizational culture and climate. The programs organizational culture and climate profiles were not significantly different from national norms. Individual-level job satisfaction and organizational commitment were unrelated to position (FSS vs. clinician) or other individual-level and organizational-level characteristics except for culture and climate. Both FSS’ and clinicians’ individual-level work attitudes were associated similarly with organizational culture and climate.     

The Feasibility and Effectiveness of School-Based Modular Therapy: A Systematic Literature Review

Modular therapies are systematic approaches to mental health treatment based on therapeutic elements common to multiple evidence-based practices. Given the flexibility and efficacy demonstrated in outpatient settings, modular therapies may be a feasible and effective approach to mental health treatment in schools. We conducted a systematic literature review to summarize the current evidence regarding modular school mental health programs, which consisted of seven studies investigating four distinct school-based modular treatment packages for internalizing concerns. In our review, no studies specifically examined modular therapy for disruptive behavior disorders—a common referral question for school mental health practitioners. Overall, the modular approach appears to be acceptable to stakeholders, but it is unclear whether school-based clinicians can implement proposed modules with adequate integrity, which limits the conclusions that can be drawn regarding real-world effectiveness. We believe implementation studies are needed to draw firm conclusions regarding the feasibility and effectiveness of modular school mental health, but the research to date appears promising.     

Improving Mental Health Services Through the Measurement of Attitudes and Knowledge of Mental Health Professionals and the General Population in Cyprus

Despite the magnitude of mental health problems worldwide, many cases of deinstitutionalization have failed to achieve their targets for a number of reasons including lack of appropriate community psychiatric services and lack of knowledge of new approaches. Therefore, the purpose of this study is to identify the attitudes, beliefs, and mental health literacy of mental health professionals and the general population toward mental illness. Method: The Attitudes toward the Severe Mental Illness (ASMI) scale was administered in both mental health professionals (n = 311) and to the general population (n = 933) to compare stereotypes and optimism with regard to mental health patients and their abilities to integrate into the society. Results: The results indicate that the general population holds less negative stereotypes (M = 2.55, SD = 0.61) than mental health professionals (M = 1.93, SD = 0.59), t(734) = 13.34, p < .001, d = 1.04. However, mental health professionals are less optimistic about the competences of a patient with a mental illness (M = 1.92, SD = 0.61) than the general population (M = 2.2, SD = .37), t(854) = 8.1, p < .001, d = .56. Discussion: The use of scales, such as the ASMI, not only make it possible to map out attitudes and views but also to measure mental health professionals' beliefs toward inclusion of these people. Results indicate that the core of the treatment needs to be shifted from the medical compliance to the satisfaction of psycho-social needs of service users. Finally, educational programs targeted at secondary education and young adults may lead to lower rates of social isolation and include more incidents of social integration.     

APAP et relation médecin-malade : quelques éléments de réflexion

In recent years, the goals of treatment in schizophrenia have evolved from objective improvements in psychotic symptoms to encompass patient-related factors such as subjective response and quality of life. Patient satisfaction with antipsychotic therapy is influenced by multiple factors. The most frequently reported reasons for dissatisfaction include drug side effects, lack of involvement in treatment planning or decision-making and lack of involvement of family members in the care plan. The majority of studies have demonstrated that the APAP (long-Acting atyPical AntiPsychotics) are associated with significant improvements in quality of life, functional status and patient satisfaction compared with conventional agents. The therapeutic alliance is the key to achieving optimal outcomes, by providing information and education to meet patients' needs, while facilitating compliance with drug therapy to ensure better clinical outcomes. A APAP that can ensure medication delivery will provide a platform for psychosocial interventions, and thus may further increase patient satisfaction and, ultimately, improve long-term outcomes in schizophrenia. Attitudes towards APAP play an important part in the treatment for schizophrenia and related disorders. The effectiveness of APAP is evident in acute and maintenance treatment of these disorders, and most mental health professionals recognize APAP as a cornerstone in treating affected people. The doctor-patient relationship is one of the most important therapeutic tools in the treatment of disabling mental disorder. Today's focus on drugs tends to make that relationship oppositional. Effective treatment requires the continuation throughout the patient's illness of the same trusted therapeutic relationships wherever the patient is located; of reliance on activities which are truly mind-building (useful and satisfying) rather than basket-weaving or its equivalent; And, as much as possible, on the continuation of medication.     

Urgent Psychiatric Services: A Scoping Review

Objective:

Urgent psychiatric services can provide timely access to ambulatory psychiatric assessment and short-term treatment for patients experiencing a mental health crisis or risk of rapid deterioration requiring hospitalization, yet little is known about how best to organize mental health service delivery for this population. Our scoping review was conducted to identify knowledge gaps and inform program development and quality improvement.

Method:

We searched MEDLINE, PsycINFO, CINAHL, Embase, and EBM Reviews for English-language articles, published from January 1993 to June 2014, using relevant key words and subject headings. Reverse and forward citations were manually searched using reference lists and Google Scholar. Articles were included if they described programs providing ambulatory psychiatric assessment (with or without treatment) within 2 weeks of referral.

Results:

We identified 10 programs providing urgent psychiatric services. Programs targeted a diagnostically heterogeneous population with acute risks and intensive needs. Most programs included a structured process for triage, strategies to improve accessibility and attendance, interprofessional staffing, short-term treatment, and efforts to improve continuity of care. Despite substantial methodological limitations, studies reported improvements in symptom severity, distress, psychosocial functioning, mental health–related quality of life, subjective well-being, and satisfaction with care, as well as decreased wait times for post-emergency department (ED) ambulatory care, and averted ED visits and admissions.

Conclusions:

Urgent psychiatric services may be an important part of the continuum of mental health services. Further work is needed to clarify the role of urgent psychiatric services, develop standards or best practices, and evaluate outcomes using rigorous methodologies.     

Patient satisfaction after acute admission for psychosis

Background Measuring patient satisfaction in mental health care potentially provides valuable information, but studies in acutely admitted psychosis patients are scarce. Aims The aims were to assess satisfaction among patients acutely admitted with psychosis, to compare satisfaction in voluntarily versus involuntarily admitted patients, and to assess the influence of symptom load and insight. Methods The UKU Consumer Satisfaction Rating Scale (UKU-ConSat) was used. A total of 104 patients completed the UKU-ConSat at discharge/follow-up (between 6–11 weeks after admittance if not discharged earlier) (mean duration of stay 4 weeks), thus corresponding to the end of the acute treatment phase. Results A total of 88.4% had total scores above zero (satisfied). Only three of the eight single items were statistically significantly different among patients admitted voluntarily versus involuntarily, and only the information item score remained significantly different in adjusted analyses. Insight level at admittance, and an increasing level of insight during the acute phase were positively associated with patient satisfaction, whereas levels and changes in positive and negative psychosis symptoms were indirectly related to satisfaction via this process of insight. Conclusions The vast majority of the acutely admitted patients were satisfied with treatment. There were few differences between the involuntarily and voluntarily admitted patient groups, except that the involuntary care group was clearly less satisfied with the information provided. Poor insight had a major negative impact on treatment satisfaction in psychosis. The provision of sufficient and adequate information is an important target for mental health care service improvement.     

Methodological advances in the use of recidivism rates to assess mental health treatment programs

This study of recidivism rates within a state psychiatric system identifies and controls for a number of flaws in other recidivism studies and provides one of the few direct comparisons between different mental health programs using recidivism rates as a dependent variable. It is not an attempt to predict the likelihood of an individual patient's recidivism or to improve the treatment provided the individual patient. Instead, it is an endeavor to address the issue of using recidivism rates to assess a treatment program's effectiveness and to examine such treatment at the macro- or system wide level.     

Impact of program services on treatment outcomes of patients with comorbid mental and substance use disorders

OBJECTIVE: This study examined the outcomes of individuals with co-occurring disorders who received drug treatment in programs that varied in their integration of mental health services. Patients treated in programs that provided more on-site mental health services and had staff with specialized training were expected to report less substance use and better psychological outcomes at follow-up. METHODS: Participants with co-occurring disorders were sampled from 11 residential drug abuse treatment programs for adults in Los Angeles County. In-depth assessments of 351 patients were conducted at treatment entry and at follow-up six months later. Surveys conducted with program administrators provided information on program characteristics. Latent variable structural equation models revealed relationships of patient characteristics and program services with drug use and psychological functioning at follow-up. RESULTS: Individuals treated in programs that provided specific dual diagnosis services subsequently had higher rates of utilizing mental health services over six months and, in turn, showed significantly greater improvements in psychological functioning (as measured by the Brief Symptom Inventory and the RAND Health Survey 36-item short form) at follow-up. More use of psychological services was also associated with less heroin use at follow-up. African Americans reported poorer levels of psychological functioning than others at both time points and were less likely to be treated in programs that provided mental health services. CONCLUSIONS: Study findings support continued efforts to provide specialized services for individuals with co-occurring disorders within substance abuse treatment programs as well as the need to address additional barriers to obtaining these services among African Americans.