Opinions to shape services

In recent years, the importance of client views in developing
health services has been increasingly emphasised but adolescent
views have not been investigated to the same depth. Evaluations of
adolescent health services have often been carried out using the
opinions of parents, teachers and service providers¹
despite suggestions that these differ from the views of adolescents
themselves.² Although these ratings are valuable,
adolescent perceptions should be gathered to enable service
development.

A study was carried out in Leicestershire child and adolescent
mental health service, which serves patients up to school leaving
age, to try and find out what young people thought and felt about
their experience with the service. Fifty young people returned a
postal questionnaire out of 157 which were posted (a response rate
of 32 per cent). The respondents identified areas that could be
changed in order to improve their experience of the services.

Perceptions of mental health services were found to be positive and
the suggestions and criticisms useful for future improvements. The
comments voiced by adolescents support the view that they would be
more appropriately treated in a separate service or with separate
facilities. The needs of adolescents can easily be misinterpreted
as the same as those of a child. This can lead to adolescents being
treated as children with a lack of privacy and little information
provided about the service and mental health in general.

Privacy and appointments without parents were wanted by some
adolescents. However, this may not be appropriate for all disorders
or circumstances; for example if the young person is self-harming
there may be a need to involve the parents.

Seventy per cent of adolescents in the study thought their general
practitioner would keep something confidential compared to 56 per
cent for their school nurse and 40 per cent for their school
doctor. Twenty-four per cent of all respondents wanted appointments
outside of school hours.

So although school-based services might provide a service away from
parents’ knowledge, many adolescents would not perceive the service
as confidential as other students might know where the user was
going. However, the use of school-based health centres could mean
the time away from lessons can be minimised. Such a service would
require a lot of effort to set up and develop links with other
agencies. If the clinicians were not solely working in one school,
their time would be taken up in travelling – not a very effective
use of their time, as few schools are likely to be big enough to
maintain a full-time clinician. Also, if school is part of the
problem for an adolescent, school-based clinicians might be seen as
part of the problem and could be seen as unhelpful.

However, it is worth noting that many young people who need mental
health services are not in school and often have many agencies
involved in their care.

Eighty per cent of respondents were satisfied with where
appointments were held, yet 28 per cent suggested they should be
nearer home and 4 per cent suggested home visits. Some suggested
that long journeys to appointments caused unnecessary stress. It
may be that there is room for improvement, although service
providers may not always be in a position to control this.

Respondents suggested that clinicians should be more welcoming or
understanding as a way to improve the service.

Comments were also made about the clinical environment. However,
some of these contradicted each other such as “room needed
brightening up more” and, in a response to how the appointment
could have been made more comfortable, by using a “darker room”.
These seem to be individual preferences but it may be that need
would be better met with separate facilities for children and
adolescents.

Two respondents suggested adolescent services should develop better
public relations. For example, the work of mental health services
could be taken into schools to make students more aware of it.
Other ways of improving understanding of services may be by
providing literature about mental health services in health centres
or in youth clubs.

Many respondents experienced prejudice such as name-calling.
However, many said nothing could be done to combat prejudice and
some thought that others should not be told who had mental health
problems. This helplessness in the face of prejudice has important
implications for self-esteem. If the adolescents think nothing can
be done to help people with mental health problems become accepted,
they may come to expect and accept prejudice.

Most respondents identify more than one reason for mental illness
but were confused as to what constituted a mental illness. This
demonstrates a good understanding of mental health but suggests
that they may not be informed about their problems or have
misinterpreted what they have been told.

In summary, many of the young people who responded had a positive
experience of contact with mental health services but were still
able to make suggestions for service improvement. This survey,
despite the limitations of the response rate, shows that young
people can play a direct role in service development if provided
with an opportunity to do so.

Catherine Taylor is a medical student at Greenwood
Institute of Child Health, University of Leicester. Nisha Dogra is
a senior lecturer and consultant in child and adolescent mental
health, Greenwood Institute of Child Health, University of
Leicester. For further information contact Nisha Dogra,
e-mail
nd13@le.ac.uk

References

¹ S Evans and R Brown,
“Perception of need for child psychiatry services among parents and
general practitioners”, Health Trends 25,  1993; and P J Leaf et
al, “Mental health service use in the community and schools:
results from the 4-community MECA study”, Journal of the
American Academy for Child and Adolescent Psychiatry, 35, 7,
1996.

² J Shapiro, C Welker and B
Jacobson, “The youth client satisfaction questionnaire:
development, construct validation, a factor structure”, Journal
of Child Clinical Psychology 26, 1997