TOPIC. How staff members and clients at a large psychiatric hospital perceived the purpose and efficacy of the treatment provided METHODS. A survey was administered to primary therapists, psychiatrists, psychologists, nurses, social workers, activity therapists, and clients (N = 171) at the sample facility. FINDINGS. Disparities existed between what staff intended and what clients perceived was happening to them. CONCLUSION. Clients who understand what brought them into the hospital, the goals of current treatment, and the importance of aftercare will demonstrate better outcomes than those who do not. Key words: Nonprimary therapist staff, primary therapist, survey From our experience in our facility, we believed that little time was taken to listen to what clients had to say about the treatment they were receiving. We also suspected that clinicians and administrators might view the treatment provided differently than clients. Thus, we decided to survey staff and clients to determine: Was any consistency seen between what was planned for clients and what actually was implemented? Did clients understand the goals of treatment and what the staff was trying to do? Methods An interdisciplinary committee at the sample hospital convened in 1985 to construct a survey that would allow these questions to be answered. This large municipal facility, one of the largest psychiatric hospitals in Canada, treats about 2,500 admissions annually. The catchment area of this hospital serves more than one half million of the city's poorest residents. The units are usually overcrowded and staff members often feel overworked. The median length of stay is a little short of two weeks. Almost 70% of the clients have had prior psychiatric hospitalization. Procedure. Surveys were administered and collected through the discipline supervisory network, then returned to the committee for analysis. Staff members were asked to indicate which of four descriptions about treatment most mirrored the treatment provided at this facility, as they perceived it. Each description of treatment was more elaborate and individualized. The second step was to survey clients about how they perceived the treatment being provided to them. Standardized instruments were considered (Moos, Shelton, & Petty, 1973), but the committee decided to develop their own instrument. Questions about the efficacy of treatment and attitudes toward outpatient treatment were included to determine if clients felt better at discharge and if so, what helped them the most? Did they need resources that were not available or not offered? Also included were questions about adequacy of length of stay, feelings about medication, and relationships with staff. In order to minimize any sense of pressure, which could confound the results, the interview was conducted by staff members not directly connected to the client's unit. Clients were surveyed as close to discharge as possible. Sample. Staff questionnaires were completed by 171 staff members from all disciplines, representing practically all the treatment staff. About 85% of respondents (n = 135) were from clinical staff such as nurses, psychiatrists, psychologists, social workers, and activity therapists. Fifteen percent of respondents (n = 36) included members from support and secretarial staff, administration, medical records, and housekeeping. Fifty-four clients responded (52% male, 48% female). The length of stay of the males was 10 days longer than the females (t = 1.02, df = 37, NS). Three quarters of the sample were admitted involuntarily, which was not significantly higher than for the facility in general ([chi square] = 2.38, NS). In terms of psychiatric history, 72% had been hospitalized at least once before, which again was not significantly different from the 75% readmission rate generally experienced at the facility. Sampling was proportional to the number of annual admissions to each of the six adult units. …