Differences in Perception of Care, Treatment, and Services Provided Among Inpatients at a State Psychiatric Hospital

Background and Purpose:

Patient Centered Care, Service User Involvement, and Service User Perspectives all describe research and treatment approaches that emphasize and respect the needs, values, and choices of patients receiving health care services.  At its core, these approaches seek to involve consumers of health care and mental health services in decisions affecting policies, treatment, and recovery processes. To properly implement client-centered policies, hospitals and other treating institutions need to ascertain relevant information from the point-of-view of the service users that extends beyond their illness and the traditional medical model.

This shift away from top-down-decision making to patient oriented health care and mental health delivery recently increased in popularity in the United Kingdom and Canada and is beginning to expand to forensic mental health facilities.  The main difficulty with applying this approach to forensic settings in the United States is the general lack of access to these institutions of care and patient population; therefore, there are significant gaps in the literature.  This research attempts to bridge that gap by ascertaining patient perspectives of treatment, care, and services at a state psychiatric hospital.

Method: The Napa State Hospital Patient Care Satisfaction Survey was administered to meet the accreditation requirements of the Joint Commission for the Accreditation of Hospital Organizations (JCAHO), which requires that the hospital collect data on patients’ perception of care, treatment, and services provided.  The survey was adapted from the Civil Inpatient Satisfaction Questionnaire (C-ISQ) a short form survey of the Inpatient Satisfaction Questionnaire (ISQ), which was originally created to meet the accreditation standard of the JCAHO in 2002. The C-ISQ has undergone rigorous survey development and testing procedures to create a valid and reliable measure of patient satisfaction.  In addition to the 11-item survey questions, eight items addressing patient quality of life were added and a series of demographic questions.

Results:  We received N=558 respondents. There was a significant effect of race on satisfaction with medical treatment at the p<.10 level for the four conditions [F(3, 379) = 2.37, p = .070], with Asian patients being significantly more satisfied than Whites, Blacks, and Latino(a)s. Women were generally less satisfied than men with the most significant differences occurring on items measuring therapeutic satisfaction at the p<.001 level [F(1, 475) = 10.29 p = .001] and satisfaction with therapeutic opportunities, p<.05 level [F(1, 471) = 5.14 p = .024].  Additionally, women were less satisfied with safety at the p<.10 level [F(1, 476) =  4.82 p = .03].

Conclusion: These preliminary results paint a portrait of patients' experiences in state psychiatric hospitals and offers some insight into areas of greatest concern to patients.  The initial results suggest patients are generally satisfied with their care.  Differences in satisfaction on measures of happiness and safety are consistent with literature measuring these items across cultures and SES.  Safety is a primary area for continued review.  The hospital may benefit from more groups discussing medication side effects. Service user perspectives in forensic mental health facilities are increasing and may provide helpful insight into improving care.