Patients' perception of user involvement in psychiatric outpatient treatment: Associations with patient characteristics and satisfaction.

Jens C Thimm,Wenche Malmedal,Liss Antonsen

doi:10.1111/hex.13132

Abstract

BackgroundThe patient's right to be involved in treatment decisions is anchored in guidelines and legislation in many countries. Previous research suggests challenges in the implementation of user involvement across different areas of health care, including mental health. However, little is known about psychiatric outpatients’ experiences of being involved in their treatment.ObjectiveTo investigate how psychiatric outpatients after treatment rate the degree to which they were included in the treatment and explore the associations between perceived user involvement, demographic characteristics of the sample and patient satisfaction.DesignCross‐sectional.Setting and participantsThe sample consisted of 188 psychiatric outpatients (67% female, mean age 42.2 years) who were discharged in the two years prior to data collection.Main variables studiedPerceived user involvement in psychiatric outpatient treatment and patient satisfaction as measured by the Psychiatric Out‐Patient Experiences Questionnaire.ResultsAbout half of the participants rated the overall degree of involvement in their treatment as high or very high. The lowest percentage of participants reporting high or very high involvement was found for sufficient information to contribute to treatment decisions (36%). Female gender, higher education and, to a small degree, younger age were associated with more involvement. Perceived user involvement was strongly associated with treatment satisfaction.Discussion and conclusionThe findings suggest that user involvement in psychiatric outpatient treatment can be improved. Patient information that facilitates user involvement should be given more attention.Patient or Public ContributionThe hospital's user panel was involved in the development of items assessing user involvement.

Highlights

Promoted by the World Health Organization and anchored in the legislation of many Western countries, user involvement is emphasized in the provision of contemporary mental health care.[1,2] This emphasis marks a shift from paternalistic to partnership-oriented models of the relationship between the health-care provider and the patient, in which both parts contribute with their expertise and experience on equal terms to achieve desired outcomes.[3,4]In Norway, user involvement emerged as a central concept in health policy documents in the 1990s
We approached patients who were discharged instead of patients who were currently in treatment because the former group had experienced the complete course of therapy and was able to answer questions about user involvement in all phases of treatment, including termination, which we deemed an important area for user involvement in mental health care
A scale based on the user involvement items showed close associations with user satisfaction regarding the quality of the interactions with the clinicians, provision of information and treatment outcome

Summary

Introduction

Promoted by the World Health Organization and anchored in the legislation of many Western countries, user involvement is emphasized in the provision of contemporary mental health care.[1,2] This emphasis marks a shift from paternalistic to partnership-oriented models of the relationship between the health-care provider and the patient, in which both parts contribute with their expertise and experience on equal terms to achieve desired outcomes.[3,4]In Norway, user involvement emerged as a central concept in health policy documents in the 1990s. Millar et al[8] proposed that user involvement in mental health care has five defining attributes: a person-centred approach, informed decision making, advocacy, obtaining service user views and feedback, and working in partnership. Millar et al defined user involvement in mental health services as 'an active partnership between service users and mental health professionals in decision making regarding the planning, implementation and evaluation of mental health policy, services, education, training and research. This partnership employs a person-centered approach, with bidirectional information flow, power sharing and access to advocacy at a personal, service and/or societal level'.8. Patient or Public Contribution: The hospital's user panel was involved in the development of items assessing user involvement

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