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Assessing the impact of mental health programs upon community: the perspectives of primary caregivers and consumers.

Since 1985, there has been a significant movement in Spanish mental health services away from provision of care in psychiatric hospitals and toward a community mental health model (CMMH). This reform has ushered in changes not only for the patients but also for both their relatives and their primary caregivers. However, no survey has ever been carried out to obtain these parties' perceptions of the CMMH. Two studies have now been designed to describe the acceptability of the CMMH to these two key groups. The goals of the two projects were, firstly, to assess the opinions of primary care professionals about CMMH and, secondly, to sample the opinions of the patients' relatives regarding mental health care. In the first survey, 884 primary caregivers (general practitioners (GPs), pediatricians, nurses and social workers) filled out a 14-item questionnaire with a five-point response scale. Several aspects of care were evaluated: accessibility, referral facilities, therapeutic support, training or teaching activities, communication between primary care and mental health professionals for their mutual collaboration, and appropriateness of resources. Most of the primary caregivers reported that the community psychiatric model improved accessibility, treatment and communication between the different levels. Nurses and pediatricians reported dissatisfaction with the CMMH. In the second survey, the satisfaction of patients' relatives with the services provided by the therapists was assessed, using the Satisfaction with Therapist Questionnaire (STQ). The STQ consists of 15 items with a three-point response scale. Amount and adequacy of the information provided, accessibility, and style of conducting the appointment were assessed as measures of satisfaction. A sample of relatives of schizophrenic patients was surveyed by mail (76 relatives answered, a response rate of 31.13%). In summary, relatives were satisfied with therapists' competence but dissatisfied with their communication skills.