LETTERS

Users’ satisfaction with psychiatry services

M.M. Singh^I; R.K. Chadda^II; J.S. Bapna^III

^IAssistant Professor, Epidemiology
^IIAdditional Professor, Psychiatry
^IIIDirector, Institute of Human Behaviour and Allied Sciences, P.O. Box 9520, Dilshad Garden, Delhi 110095, India

Correspondence

Sir – The quality of patient care services provided by hospitals can be estimated by the level of consumer satisfaction (1). In psychiatry, a discipline with which stigma is associated, acceptability of services by patients and their families is likely to be a key element in treatment and recovery (2).

Studies on users’ assessment of mental health care provided by hospitals in India are scanty. We assessed the level of satisfaction with the hospital services in 104 randomly selected subjects (45 patients and 59 relatives of patients) attending the outpatient clinic of a tertiary neuropsychiatric centre in Delhi. A semi-structured questionnaire was used to elicit information on 19 items related to efficiency; communication and behaviour of doctors, nurses and reception staff; waiting time; quality of clinical care; and supportive elements such as food, cleanliness, and the general atmosphere of the hospital.

Eighty one per cent of the patients had been attending only the outpatient services, whereas 19% had also been admitted at some time during the course of their illness. The duration of treatment varied from 2 weeks to 180 months (median: 1.52 months) with the number of visits ranging from 2 to 350 (median: 12).

The efficiency of doctors was perceived to be high or moderate by 57% and 43% of the subjects, respectively, and the availability of doctors was found adequate by more than 90%; 95.2% of respondents reported that the doctors were punctual and freely discussed the patients’ problems, and 80% assessed waiting time for consultation at less than 2 hours. The efficiency of the nursing staff was rated high (39%) or moderate (61%), and most of the study subjects found their behaviour cordial. Punctuality of the reception staff was assessed as good (50%) or satisfactory (50%), with waiting time at reception and registration less than half an hour for nearly all (99%) of the respondents. Clinical care was rated to be good or satisfactory by 93% of the respondents. The supply of drugs and the quality of diet were found to be satisfactory among 75–80% of subjects, though there were some suggestions, specially with regard to increasing the availability of drugs.

One particular action has contributed to the degree of satisfaction with services. Public hospitals in developing countries suffer frequently from overcrowding and, at some places, the service users may have to wait for hours. In the present setting, a system of numbered, coloured tokens has reduced the waiting time at reception, registration counters and consultation rooms. The tokens correspond to specific clinic rooms, thus ensuring equitable allocation of clients to physicians and reducing congestion.

Of the 45 participating patients, only 12 felt stigmatized by their mental health problem, the most common reasons being disrespect from relatives and segregation by family and others. Stigmatization affects the treatment-seeking behaviour of mentally ill people. It can be reduced by creating awareness of the availability and effectiveness of modern treatment methods for mental disorders and improving the quality of mental health services. Many studies in outpatient settings (2–5) have reported user satisfaction of 60–80% according to different variables. The results of our work also show a high degree of satisfaction among users.

There is evidence that users of mental health services can usefully assess the care they receive (1). However, studies involving patients may suffer from several drawbacks, including low reliability because of lack of technical knowledge, faulty judgement by severely ill patients, and methodological difficulties of measurement (5). The findings of our study cannot be generalized because of the small sample size and the lack of consideration of social factors, and because the nature of the illness may influence patients’ opinions. However, the response of patients’ relatives may be considered reliable, based on their experiences and observations of the hospital services. Such studies are important as they provide feedback about hospital services and should form an integral part of the quality assurance system in various settings of health care.

1. Ware JE, Davies-Avrey S, Steward AL. The measurement and meaning of patient satisfaction. Health and Medical Care Service Review, 1978, 1: 1.

2. Lebow J. Consumer satisfaction with mental health treatment. Psychological Bulletin, 1982, 91: 244–259.

3. Batch P et al. Client evaluation of community mental health services. American Journal of Community Psychology, 1977, 5: 243–247.

4. Lorefice LS, Borns JF, Keefe C. Consumer evaluation of a community mental health services: care delivery patterns. American Journal of Psychiatry, 1982, 139: 1331–1334.

5. McPhee C, Fusmann J, Joss RH. Measurement of patient satisfaction: a survey of practices in community mental health centres. Comprehensive Psychiatry, 1975, 16: 339–404.

Correspondence
J.S. Bapna
Director, Institute of Human Behaviour and Allied Sciences
P.O. Box 9520, Dilshad Garden, Delhi 110095, India