Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship.

OBJECTIVE: Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of this study was to explore how dimensions of consumer preferences for shared decision making (i.e., preferences for obtaining knowledge about one's mental illness, being offered and asked one's opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction. METHODS: Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction. RESULTS: Preferences for involvement in treatment decisions was the unique component of shared decision making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: When consumers with serious mental illnesses express preferences to be involved in shared decision making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers' interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision making should occur within the context of a strong therapeutic relationship.

HIV and hepatitis C knowledge among individuals with serious mental illness.

OBJECTIVE: The present study examines knowledge of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among individuals with serious mental illness. METHODS: Two hundred and thirty-six people answered questions regarding their knowledge of HIV and HCV. RESULTS: The total correct score for the set of HIV items (79%) was significantly higher than the total correct score for the set of HCV items (70%). Although the majority of demographic variables were not significantly associated with knowledge, individuals who had been previously screened for HIV answered significantly more HIV and HCV questions accurately. CONCLUSIONS: These results indicate that there is a specific gap in knowledge about HCV among individuals with serious mental illness, suggesting the need for intervention development to increase disease-related knowledge.