Consumers Tell NYC Mental Hygiene Department What's Good for Consumers
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 recent 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 suffer adverse consequences. He indicated that he has already begun to hold responsible providers of early intervention services for their performances. Adult mental health treatment services and selected mental retardation/developmental disabilities (MR/DD) services 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 consumers' perceptions of care. 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 indicators of 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 in the Department of Psychiatry 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 consumer 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 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 implement continuous quality improvement projects on a rotating basis. Two of the first groups will focus on consumer perceptions of care-mental health on the one hand, mental retardation-development disabilities on the other hand. In the future, there will be work groups on alcoholism and substance abuse. These work groups will consist of stakeholders (consumers, providers, and family members) with experience measuring the quality of care.
Department to Publicize Best Providers
At forums held by the Department on October 27 and November 3, consumers and providers presented their views and work on quality improvement. Consumer speakers 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." Of the nearly 250 consumers and providers who attended the forums, including administrators and clinicians, 160 responded to the Department's pilot survey. Their answers confirmed that consumer perceptions of care are important to the measurement of quality.
The Department is currently developing for Quality IMPACT a website to be up and running by February 2004. The results of the pilot survey, as well as other information pertaining to the initiative, will appear there. The results of other "perception of care" surveys by consumers will also be publicized on the website.
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. If you would like to contact the Department for additional information or to provide feedback on the Quality IMPACT initiative, contact King at 212-219-5485 or cking1@health.nyc.gov; also Lily Tom at 212-219-5617 or lmtom@health.nyc.gov. Cheryl King added, "We are excited because Dr. Sederer is willing to make significant 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."