Recent work identifying the wishes and preferences of patients and relatives about mental health care is summarized and discussed in the light of earlier findings.
Patients want more information and involvement in decision-making, good relationships with providers, clear management plans, good coordination among services, the opportunity to record their wishes in advance directives, and contact with fellow patients who can provide peer support. Clinical outcomes are predicted by patients' perceptions that services have met their needs. Relatives also want information and support, and good communication with services. Relatives, however, request more supportive and intensive interventions, whereas patients prefer options which preserve their independence. Professionals have difficulty in identifying their patients' priorities and desired outcomes of care.
Much attention has been devoted recently to establishing mechanisms by which patients can be involved in service development and planning, but it is not clear whether patients wish to be involved in this or feel involved. It may be that the majority of patients want more involvement in their own care as a first priority. Further work in this area would benefit from greater consistency in terminology and measurement, and should consider the views of other stakeholders, such as those responsible for the development and resourcing of services.
aUniversity College London and bBarnet, Enfield and Haringey Mental Health NHS Trust, London, UK
Correspondence to Dr Lorraine Noble, Senior Lecturer in Communication Skills, Academic Centre for Medical Education, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW, UK Tel: + 44 20 7288 3378; fax +44 20 7288 3322; e-mail: firstname.lastname@example.org