Published: 06/10/2005 Volume 115 No. 5976 Page 19

User surveys show some service gaps in mental health - but It is not all doom and gloom, say Vanessa Pinfold and colleagues

The Healthcare Commission has just published the results of its mental health patient survey 2005, which captured the views of 26,500 users of psychiatric clinics and community mental health services.

While 77 per cent find overall care good, very good or excellent, they also report significant gaps. Notably, 52 per cent of patients did not have a phone number for someone to contact in an emergency, implying failure on a key national service framework target.

Rethink has also recently conducted a survey of people using our services, receiving 1,483 responses. The findings are similar, with praise and criticism in users' responses. The challenge for the NHS and Rethink is to respond to the feedback we have received with timely and appropriate actions.

Like the Healthcare Commission, Rethink found high levels of satisfaction with overall care: 88 per cent compared with its 77 per cent. These levels of satisfaction are shaped in particular by positive relationships with key individuals.

NHS patients reported being treated with dignity and respect (97 per cent), confidence in their psychiatrist (90 per cent) and psychiatrists who listened to them (95 per cent). However, where continuity of care problems were reported, levels of satisfaction were lower.

Similarly, Rethink service feel staff treat them with dignity and respect (93 per cent); feel listened to (95 per cent); and 93 per have trust and confidence in those supporting them.

These are important messages for staff to hear in a healthcare sector severely affected by stigma and discrimination as well as recruitment and retention difficulties.

What can we learn from such surveys?

Some of the messages, particularly from the commission's survey, are long standing, serious problems for mental health service users and their families.

Many are issues that Rethink have been highlighting in campaign work and research reports.

Aside from the vital question of someone to contact in an emergency, the age-old issue of information raises its head: 35 per cent of people were given no information about potential drug side-effects, and one in five felt they had no say in deciding which medication to take.

Only 40 per cent had access to talking therapies and 79 per cent were not in paid employment, although half wanted to work. In Rethink's survey, a key message came from the 33 per cent of users who did not feel involved in the running of their service. A further 25 per cent were unsure of their role.

Despite commitment to user involvement, progress towards this goal is often slow in both voluntary and statutory sector service providers.

Perhaps we should ask why change is so difficult to achieve in mental health.

Recently, Rethink undertook a programme of work with the Institute for Public Policy Research to explore some of this ground and to create a vision for the future.

Service users and carers explored alternatives to the current services in focus groups. Their vision for the future was founded on the need for a fundamental shift in public and professional attitudes towards people with a diagnosis of mental illness.

They wanted new and accessible routes into care, real alternatives to inpatient care, opportunities for employment and the chance to make a difference. These surveys suggest that some of this is happening, but we have a long way to go.

Vanessa Pinfold and Alison Faulkner are research managers on the Rethink research team and Adele Greaves is research officer for Rethink severe mental illness.

Would you like to contribute to Speak Out? E-mail susan. delgado@emap. com