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Involving users in the delivery and evaluation of mental health services
- Alasdair J Macdonald (30 November 2002)
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Child consumer and parent/carer involvement
- Jolyon R Grimwade (17 December 2002)
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Alasdair J Macdonald, Project Director Mental Health Institute, St Martin's College, Carlisle CA1 2HH
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When the Government’s National Service Framework was published, North Cumbria Mental Health and Learning Disabilities NHS Trust seized the opportunity to involve service users at all levels. Both users and staff have benefitted from this initiative. The Trust now employs a full-time User Involvement Coordinator through the Mental Health Institute at St Martin’s College in Carlisle. Competing interests: None declared |
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Jolyon R Grimwade, lecturer in Psychology, Victoria University Victoria University, Box 14428, MCMC, Melbourne, Australia, 8001
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The gathering together of available studies is a valuable exercise. But the lack of such studies amongst consumers of child and adolescent mental health services appears even more problematic than for adult consumers. Clearly such research for adults involves a number of barriers, not the least of which is the surety of purpose of the consumer as they confront internal states and external indifference. Structurally, the adult consumer does have a target for their input. Also, the adult consumer can report personal experience that can be related to other consumers and their confrontations with professionals, according to both diagnosis and structural perspectives. Further, adult consumers do have some mentors/advocates from whom to seek advice. In child mental health none of these conditions for breaching barriers seems to exist. Only the older children can advocate for themselves, the younger ones have to rely on their carers. Thisis not a problem of itself, necessarily, but as has been found for adult consumers,relying on parents can lead to distortions of voice that involve the presenting of the parents in favourable ways. Secondly, diagnosis in child mental health is rarely stable enough to develop a view of how services affect a diagnostic group, systematically. Child mental health works most often with reactive conditions or conditions which the interventions may well lead to the alleviation of the diagnostic status. In turn, the safety in numbers and the strength that comes from sharing experiences is much more difficult to establish; let alone have a critical mass that encourages others to join such a process and become advocates. In turn, patterns of systematic professional conduct are not easily discerned or assembled as a recognisable service barrier that would require re-design. Thirdly, chronic diagnoses in child mental health do draw like experienced parents together, but as advocacy groups for their particular disorder (ADHD, Autism, Asperger's, and probable others that I do not know of) to gain service, rather than to moderate service in favour of consumer experience. These advocacy groups are begging for service rather than seeking to re-model it. Further, the groups involve relatively rare syndromes, as against the adult psychiatric population which has very large numbers of consumers withinb each diagnosis. Given these differences, can the authors (Sampson and House, 2002) envisage consumer-led experience being able to be brought to bear on the functioning of child and adolescent mental health services? Or, what lessons from adult consumer input to program re-design might apply in child and adolescent mental health? Thankyou to the authors,
Competing interests: None declared |
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