The Mental Health System: How to Make it Better

One of the main goals of QSAN, Inc., in conducting our surveys, is to gauge the ideas, opinions, and attitudes of our consumer sample. Our interviews with consumers give them a chance to “sound off” about the mental health system; QSAN can then help to initiate change for the better within the Ohio system. This writer used to be an interviewer for QSAN, and the most exciting aspect of the job was interacting with the consumers as we asked about their opinions.

Historically, answers to QSAN's survey question, “What would you like to see done that would make the whole system better for people who use mental health services?” have proved very productive in terms of eliciting illuminating responses from our consumer clients. Many themes emerged from QSAN's 2002 report regarding this query. The largest percentage (32%) of responses said that more information, awareness, and education about many things related to mental health was needed. More and better services in the system was the second largest grouping (13%) from this report.

There were many other important themes that emerged. Some of these were being treated with respect and listened to more closely by providers, more clubhouse services, and more case managers. Other issues that surfaced were: increasing public awareness and therefore reducing stigma regarding mental illness, better access to services, improving the financial aspect for consumers seeking services, and providing transportation.

We thought that a look at this question from our more recent data would prove noteworthy. So this writer researched consumer answers to the question of “What would you like to see done that would make the whole system better for people who use mental health services?” for the years 2003 and 2004. The total number of consumer interviews for the 2003-2004 period was an 'N' of 626 surveys done. It is important to note that often consumers mentioned more than one item, so the total number of responses to this question equal more than 626. However, for approximating percentages, the N of 626 was used.

As we have stated in our reports to the stakeholders before, although we report on areas of the mental health system that our consumers would like to see improved, it is important to observe that much is going well within the mental health system. The largest group of responses to this question was 103 responses, or 16%, that said the system was “good as it is.” Typical responses were that the system is “fine as is,” or that it is “okay” now.

Eighty-nine consumers, or approximately 14%, said that they would like to see less waiting to get into services, better accessibility, and more and better services. They said such things as they had to “wait too long,” and that the system needs “better scheduling.” More and better services was a constant refrain, just as it was in 2002. Registering also at 14%, with two fewer responses, was a very important issue with consumers. This issue is that consumers want to be treated better and with more respect by providers, and consumers sometimes feel that they are not being listened to by providers. The attitude of an effective provider is one of compassion and understanding for their clients. The old “medical model” in which the provider dictated to the consumer has long since been replaced by the “recovery model” where the consumers' opinions are respected, and they have an active role in their treatment plans.

More funding and more staff in general accounted for 12% of the answers as to what would make the system better. As in 2002, many remarks from consumers called specifically for more case managers, precisely 5%. Add this figure to the aforementioned 12% and it becomes overall the largest response to this question at 17% of the total answers. Not only do consumers want more staff to take care of them, they also said that they wanted their providers to spend more time with them (2.5%). One consumer specifically said, “There isn't enough time to work through my problems,” and requested “more time with health care providers.”

Transportation to and from services has been an issue from the time we first started doing interviews in 1996. Transportation emerged as an early theme in areas where the mental health system needed improvement. Since QSAN, Inc. has expanded to include the very rural counties in the southern Appalachian region, transportation has grown in significance as an issue. Thirty-nine responses, or 6%, said transportation, or closer services, were needed in their areas.

As in the 2002 report, education, more information, and awareness of services available accounted for a significant amount of responses, at 8%. Not only education for the consumer alone, but education for the public at large was mentioned. Education is the way to eradicate the stigma that still exists regarding mental illness among many in the community today. Several consumers communicated that they have encountered this stigma.

An area that has always proven problematic to the consumer population has been the issue of affordable housing. Many consumers completing our survey are on a fixed income. Most consumers want to work, but are unable to find jobs, and so must subsist on their Social Security benefits. More and affordable housing was mentioned by 3% of those responding to this question. There are long waiting lists for subsidized housing, and many consumers in the community are faced with homelessness.

Many more issues cropped up from the sum of responses as to what would make the system better for people who use mental health services. These responses did not total up to significant percentages, but nevertheless warrant a mention, as several consumers said nearly the same thing. Medication is an issue with many consumers. One typical response said, “They should rethink the way they administer and prescribe medications. They think higher dosage[s] and more medication is the answer to everything.” Another consumer said, “People improve and get better when they are not dependent on meds.” Consumers do not want to be forced to take medications when they are not so inclined.

Several consumers reported that they would like to have a job. In the same general area of concern, finances were mentioned. Many consumers are at or below peverty level, and need affordable or free medications and services. One person said, “Clients being able to afford meds when needed.” Another response was, “Can't afford drugs. Co-pay [is] high.” More peer support groups were reported by some consumers as being needed. Privacy issues and confidentiality were mentioned by some of the consumers surveyed. QSAN regards confidentiality as of utmost importance. Our interviews are done on a confidential basis, and the consumer's name is removed from the instrument as soon as the QSAN staff processes the interview. We are able to get good responses from people because they trust us to keep their replies confidential.

This monthly update can be regarded as a preview of the upcoming biennial report covering the period since our last report in 2002. An outside university consultant is currently working on the QSAN, Inc. report covering 2003 and 2004, and it is expected to be published in March 2005. The report will go up on our sister website, www.consumerfacts.org shortly thereafter. Keep a close watch out for the new report!

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