Service users’ expectations of treatment and support at the Community Mental Health Centre in their recovery

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Taking a user‐oriented approach means acknowledging the individual's own expectations, aims and hopes. In mental health, knowing and respecting the service users’ personal expectations and goals is particular relevant, and this notion is reflected in contemporary approaches such as shared decision‐making, motivational interviewing and goal setting. Studies on the role of service users’ expectations have shown that expectations about treatment and treatment preferences predict treatment outcomes 1 and satisfaction with care 6. Some studies have also shown that service users’ expectations of treatment are changing in the light of accumulated experience 7; if expectations are not met, motivation for treatment may drop 10. Consequently, recognising service users’ personal expectations and aims at the start of treatment is important from both the perspective of the person who uses mental health services, his professional helpers and those who plan and develop mental health services.
Research on the role of expectations in psychotherapy treatments regard expectations as a central but sometimes undervalued element 5. The current literature divides service users’ expectations into two categories 5: Treatment expectations reflect beliefs about what will transpire during therapy, including the respective roles that the service user and the health professional will adopt 2, the format of treatment and the duration of treatment 5. Outcome expectations centre on the following question: ‘To what extent do I believe that a given treatment will help me with my problems?’12.
As for expectations about treatment, earlier research has shown that service users in specialist in‐patient services expect to have a safe environment in which to receive treatment and that the treatment will involve developing relationships with staff 13. Service users’ expectations are individual, and some service users value treatment that focuses more on counselling, others prefer medication first, or both 15.
With regard to outcome expectations, service users with schizophrenia in one study assessed well‐being in the domain of confusion as most preferred treatment outcome, followed by energy, symptoms, work, social life and side‐effects 16, and also other studies have shown that for many well‐being and energy, social relations and productive activities (such as having a job) may be treatment goals just as important as the amelioration of disturbing symptoms 16.
Including the perspective of the persons using the services should be mandatory when exploring phenomena such as expectations and experiences in the areas of health and social care 22. However, in a recent review of preferences for medication‐associated outcomes that included 16 studies, only six studies sought input from service users when outcomes had been chosen 24. The notion that valid knowledge is based on the perceptions of service users is central in a recovery perspective 25.
The process of recovery is typically described as subjective and unique, taking place within the context of the person's everyday life 26. It is a process that is comprehensive and involves individual, social 27 and material factors 31. Recovery research is frequently based on the narratives of persons with severe mental illness who have been using mental health services for many years. Very few studies have investigated the early phases of recovery. This is particularly true for the Nordic setting, where little research has been performed within the recovery perspective in general 32.
As in many western countries, a process of closing or downsizing mental health institutions has recently taken place in Norway. During a major national effort from 1998 to 2008, the number of Community Mental Health Centres (CMHCs) was increased to 75 33.
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