Guardian -- Form of torment

This is a mental health story type I look for
Thought I would print as well bit over long

http://society.guardian.co.uk/social...043907,00.html

This whole story is something i can say about having been sent one before
no more after that
coz Filled the thing was told complete anynomous
Post in box did have copy of answers myself
Post in pillar box what do i see a number in small printed envelope just as
slipped out hand
same number written on form
ID----

This is Tag line Caught Me Eye----

PREVIEW: WHAT'S IN TOMORROW'S SOCIETYGUARDIAN SUPPLEMENT

* Feature: Form of torment - the NHS says it wants to really
understand the experiences of mental health service users. So what,
asks Clare Allen, is this pointless questionnaire doing on my desk?



Form of torment


The NHS says it wants to really understand the experiences of mental health
service users. So what, asks Clare Allan, is this pointless questionnaire
doing on my desk?

C---- A---- -- Name Muffed
Wednesday March 28, 2007
The Guardian


Afew weeks ago, I received a questionnaire from a company called Quality
Health. An accompanying letter informed me that I had been randomly selected
to take part in a survey about my experiences of NHS mental health services
over the past 12 months. My views, said the letter, were very important.
This was my chance to have a say in how mental health services would be
provided in the future.
I confess I was excited. As a service user for the past 12 years, this was
the first time I could remember ever being asked for feedback. Sure, I had
offered feedback from time to time, but, generally speaking, it had been
received with that special combination of irritation and embarrassment that
is reserved for unwanted gifts. Now my opinion was being sought. I was
cock-a-hoop! So why, weeks later, is the survey still sitting on my desk?
The Service User Questionnaire consists of eight pages of multiple-choice
questions. On the final page, there is a box, measuring 8cm x 19.5cm, for
additional comments. The questions, for the most part, have three possible
responses: "Yes, definitely"; "Yes, to some extent"; and "No".
Straightforward enough, you might think. And, in all fairness, it should be
acknowledged that Quality Health could hardly have done more to facilitate
my understanding. So judicious is their use of UPPER CASE and bold type, it
would be hard not to get the gist. Take the following, for example:
The LAST time you saw a psychiatrist . . .
4. Did the psychiatrist listen carefully to you?
Yes, definitely
Yes, to some extent
No
5. Did you have trust and confidence in the psychiatrist you saw?
Yes, definitely
Yes, to some extent
No
Still thinking about the LAST time you saw a psychiatrist ...
6. Did the psychiatrist treat you with respect and dignity?
Yes, definitely
Yes, to some extent
No
Despite my very best efforts and a series of calls to the helpline number
given in the letter, I am still struggling to fit my answers into the
options available to me. In short, I understand what they are asking, but my
problem lies in how to respond.
The last time I saw a psychiatrist was a few days ago at the gym. We
exchanged a glance of recognition before electing to pretend we hadn't. But
I don't think this is what Quality Health has in mind.
My last meeting with a psychiatrist took place about two months ago. We met,
together with my social worker, in a poorly soundproofed room at the local
community care centre. I'd had to take my dog to the meeting. The
psychiatrist remarked on this in a manner I found irritating. I also felt
that she talked too much, and more than once she asked me something I had
told her five minutes before. On the plus side, she did not sit picking her
teeth as I described my innermost feelings, nor did she discuss me like a
cat at the vet's, directing her comments to my social worker - both of which
have happened with doctors in the past.
So did Dr X, as I will call her, listen carefully? My immediate feeling is
"No, not really", but this is not an option. I wouldn't say she did not
listen at all; it is the "carefully" bit that I have issues with. She
listened, but not very carefully. But did she listen carefully "to some
extent"? I'm not sure what this means. Did she listen a little bit
carefully? Or did she listen carefully a little bit? I'm not convinced she
listened carefully at all. But she did listen. And if I put "No", they will
think she did not, and that would be wrong. My views are "very important",
so I need to get it right. In the end, I cross out "carefully" and tick
"Yes, to some extent". This seems best to represent my position, though it
is not, strictly speaking, an option on the form, and I am not sure what
Quality Health will make of it.
Now for trust and confidence. Did I have trust and confidence in Dr X the
LAST time I saw her? Trust and confidence? I'm starting to sweat. Trust?
Would I lend her a fiver? Yes. Well, no, not after the dog thing, but she
wouldn't need it; psychiatrists are loaded. And that is not what they mean.
Confidence, then. Did I have confidence? And how about respect? And dignity?
Did she treat me with dignity? My eye wanders down. There are 58 questions.
I take a break. I am starting to panic.
I ring my friend, Peter, a fellow service user, in search of some support.
Peter listens carefully as I tell him about the survey. "That must be what
my CPN [community psychiatric nurse] was talking about," he says. It turns
out that Peter's CPN has just called. She rang him to ask if he had been
sent a user survey, but he hadn't. "I've got a script I'm supposed to read
you," she said, and began reading.
Dangerously off script
It started with, "Hello Peter, this is Fiona, your care coordinator." Fiona
has been working with Peter for more than seven years. There were options
for Fiona to follow, according to whether Peter had received the survey, had
not received the survey, or did not know whether he had received the survey
or not. "I'm not happy about it, Peter," she said, veering dangerously off
script. "I don't think we should be in any way involved with a survey
assessing the care we provide."
She went on to explain that the mental health and social care trust was
worried because so few people had returned the questionnaire. In fact, the
chief executive of the trust was so concerned that she had written to every
care coordinator instructing them to ring their clients, and enclosing a
script to assist them. Fewer than 7% of selected users had returned their
surveys, which put the trust at the bottom of all trusts nationwide. Oh
dear.
In my experience, service users often have a lot to say about the care they
receive - what works, what doesn't, and how things might be improved. Their
workers have plenty to say as well, after years of experience on the
frontline, dealing with issues as they arise, coping with the impact of
changes dictated from above. And, generally speaking, these two groups
agree.
This is not a scientific survey, mind; it is what I have observed. The
trouble is that what they have to say does not always fit neatly into boxes.
And it is not always what the powers-that-be want to hear.
The policy makers want figures to prove things are getting better; to prove
that it does not matter if, according to a report by the mental health
charity Rethink, spending on mental health services is down by £30m - a
figure the Department of Health disputes, putting the decrease at £16.5m.
Who cares either way? It is money well saved. Just look at these statistics.
According to my local trust's annual report, last year's service user survey
"showed that 95% of service users consider that their psychiatrist listens
carefully to them and 97% feel that their psychiatrist treats them with
respect and dignity". But what does this mean? And does that include the
"Yes, to some extent" answers, as well as "Yes, definitely"? In other words,
everything other than "No"?
Measured and graded
Of course, the problem of service assessment extends far beyond the field of
mental health. Star ratings and rankings increasingly invade every corner of
service provision. There is nothing, it seems, that cannot be measured and
graded and shown to be improving. But do these statistics tell us anything
useful at all, or are they an attempt to simplify complex human experience
to the point where it has no meaning?
There is nothing new about this question. Aristotle grappled with it 2,300
years ago. In Nicomachean Ethics, his work on virtue and moral character,
the philosopher writes: "We must not expect more precision than the subject
matter admits of ... for it is the mark of an educated man to look for
precision in each class of things just so far as the nature of the subject
admits." I couldn't have put it better myself. Quality Health, take note.
Some names have been changed.

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