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Consumer Perceptions are Important

After years of telling patients what's good for them, mental health professionals are now asking consumers their opinion. The New York City Department of Health and Mental Hygiene wants to know which programs not only promise mental health but also deliver it.

Why the change in attitude? More consumers are advocating for their mental health and the budget crunch means programs must be more efficient and effective. Whether they will be depends on a new initiative by Lloyd Sederer, MD, the Department's Executive Deputy Commissioner for Mental Hygiene Services.

At a forum in Manhattan on September 30, Dr. Sederer explained to 200 consumers the Department's handling of such issues as recovery, peer services, housing, police relations, and employment. The forum was organized by most of the consumer groups in the city, with the help of concerned providers. The theme that ran throughout Sederer's responses was "quality improvement." In other words, providers must satisfy consumer needs or they will lose their contracts with the City. He indicated that he is already holding mental retardation/developmental disabilities (MR/DD) providers responsible for their performances. Mental health organizations are next.

NYC Initiates Quality Improvement

Quality IMPACT (Improving Mental Hygiene Programs & Communities Together) is the name of Dr. Sederer's initiative to improve services based on measurements of quality. A big part of determining that quality is evaluations by consumers. Said Cheryl King, the Department's new Director of Quality Improvement and Outcomes Management, "The scientific literature shows that consumers' perceptions of services are valid for predicting outcomes. For example, we want to know whether clients are getting appointments fast enough, is the treatment they receive culturally appropriate, or are those with a dual diagnosis finding the program they need?" King is the former director of Clinical Systems at St. Lukes-Roosevelt Hospital.

If this type of evaluation sounds like common sense to consumers, it's partly because many consumers now provide mental health services to their peers. These consumers have learned that performance measures are a valuable tool for improving services and not just a way of holding peer advocates to a higher standard. Yet, consumer advocates should assure that performance standards are indeed sensitive to individual differences.

City Involves Consumers in Quality Improvement

How will the Department determine the right measurements and then get providers to improve their services based on the measurements? The Department has established an external advisory committee of providers and consumers, including the Coalition of Voluntary Mental Health Agencies, the National Alliance for the Mentally Ill, the Baltic Street Mental Health Board, Howie the Harp Peer Advocacy Center, the Health and Hospitals Corporation, the Morningside-Westside Community Action Corporation, Volunteers of America, and Community Access.

The Department is setting up work groups to deal with issues on a rotating basis. The first two groups will focus on consumer perceptions--mental health on the one hand, mental retardation/developmental disabilities on the other hand. In the future, there will be work groups on alcoholism and substance abuse. The Department is seeking people to serve on the work groups who have experience measuring the quality of care. Those interested in serving should contact Cheryl King, (212) 219-5485 or cking1@health.nyc.gov; also Lily Tom (212) 219-5617 or Lmtom@health.nyc.gov.

Department to Publicize Best Providers

At forums held by the Department on October 27 and November 3, consumer and provider advisory groups presented their work on quality improvement. They emphasized services that enable consumers to function better rather than services that relieve symptoms. What are the skills and interpersonal relations that allow them to live satisfying lives? King stated that the presentations were helpful because "we don't have a lot of data on these measures." The 160 consumers and providers who attended the forums, including administrators and clinicians, responded to the Department's pilot survey. Their answers confirmed that consumer perceptions are important to the measurement of quality.

The Department hopes to offer this and other surveys on its website by February and to publicize the preliminary results on which organizations are best. In the first year of Quality IMPACT, the Department will determine which organizations overall offer the best services. In the second year, they will measure individual programs of each organization with which they contract. Each organization will have the opportunity to identify improvements they will make to achieve the Department's standards.

In addition to studying consumer perceptions, the Department will establish other priorities for measuring quality performances, such as whether providers use evidence-based practices, including psychoeducation, medication management, peer counseling, and supported employment. Cheryl King encouraged providers and consumers to supply evidence of other effective treatments.

King added, "We are excited because Dr. Sederer is willing to make massive changes in the Department's programs. This will require tremendous in-house training and public education. Incremental improvements will require heavy lifting at the beginning but once we get used to it change will come more easily."