Auseinetter - Issue 8
Consumer Involvement
A particular challenge of the Auseinet project and of course, of all services providing direct or indirect treatment and intervention to children and young people is that of facilitating meaningful consumer participation. Indeed, the National Mental Health Policy and Plan specified consumer rights as one of the 12 policy areas for reform under the strategy, as well as defining specific objectives and strategies for implementation. Significantly, the recently released report of National Stakeholders Consultations contained in the Evaluation of the National Mental Health Strategy (Manderscheid and Pirkis 1997) stated that consumer empowerment was considered to have improved substantially under the Strategy, particularly at a national (and to a slightly lesser extent, State/Territory) level. Consumer involvement on bodies such as NCAG were applauded as were opportunities for networking and information-sharing at venues such as the THEMHS Conference (ibid, page 5). It was notable, however, that the `trickle down' effect to the local level was `still patchy, with many consumers still feeling disempowered, for example, when it came to influencing their own treatment' (ibid, page 5). The Strategy was felt to have achieved less with regard to the rights of carers.
In attempting to explore how to encourage `meaningful' consumer participation in the Auseinet project, the project have examined the following questions:
- why is consumer involvement needed?
- what is `meaningful' consumer involvement?
- what strategies facilitate meaningful/effective consumer involvement?
- How can the needs of both consumers (young people) and carers be represented?
We are still grappling with these questions. Some of our thoughts appear here and we welcome your comments and suggestions.
Why consumer involvement? - the importance of finding a voice
Finding a voice means that you get your own feeling into your own words and that your words have the feel of you about them (Seamus Heaney 1980:17).
One of the major changes occurring in human service agencies in general is a long overdue shift away from a disproportionate focus on service providers to clients/ consumers of services. Effective consumer feedback systems have long been seen as providing benefits to the business sector by means of customer satisfaction surveys (Hirschman 1970). More recently, however, it has been postulated that effective client/customer feedback systems can provide benefits to managers and clients of human service programs including mental health services. Unfortunately, however, national policy does not state how this is to be supported and encouraged at the local level. Client/consumer participation can be part of strategic planning; service planning; policy development; service delivery; quality management; and review and evaluation (Donabedian 1992). Additionally, writers such as Draper (1997) and Jones and May (1992) have asserted that consumer participation can enable better functioning of human service teams and create more open culture in agencies whereby consumers/ clients become allies in service delivery.
The move towards the development of client / consumer feedback systems in human service agencies has not been without criticism. Some writers have questioned whether the concept of `consumer satisfaction' which comes from the business sector can be applied to the non profit social service sector, given the differing perspectives and backgrounds of people in these systems. Particular difficulties in relation to giving clients/consumers `a voice' have also been raised. It has been suggested that the uneven power relationship existing between human service workers and clients will give rise to problems in staff collecting data (Wilhite and Sheldon 1997). Moreover, it has been suggested that clients who receive human services such as child protection services or mental health services are often unlikely to be seen as critical of service providers and experience difficulty in bringing into language a critique of existing services (Ringma and Brown 1991).
Despite these challenges, it is argued that clients of human service agencies such as mental health services need to be given a `voice'. The rationale for this comes from a range of theoretical frameworks which have an ethical, rights-based or consequentialist basis:
- The ethical framework stresses the concept of client autonomy and self determination. Consumer research continually elicits from consumers the comment that they want to be `treated with respect, like a person' (Entwhistle 1997:426).
- The rights-based approach incorporates the notion that clients/consumers have rights, for example, to information, choice, safety, fair treatment and redress
- The consequentialist approach judges the rightness of the approach from the point of view of the consequences. This approach underpins the attempts to provide evidence, based on research, that outcomes are improved by developing partnerships with clients/consumers or services
The concept of consumer involvement or consumer participation embraces a number of areas including participation at the individual level, policy, planning and decision making processes as well as service delivery levels.
Considerable work has been undertaken on the development of client feedback mechanisms and other mechanisms to give clients `a voice' in the health and mental health systems. (See for instance Draper 1997 and National Mental Health Plan 1998). Despite this, however, actual operationalisation of this still has a long way to go. A recent discussion concerning consumer involvement on the EINET email discussion list noted that while national policies state that consumer participation in services is a `must', policies lack information on how this is to be supported and encouraged at the local level.
Particular questions which have been aired on the EINET site are as follows:
- What is `meaningful' consumer representation?
- What strategies can be employed to encourage consumer participation?
- Who determines who should represent whom?
- How do you ensure the representativeness of consumers?
- How do you support and encourage consumers at the local level?
An interesting paper on consumer and carer involvement presented at the 1997 THEMHS conference by Sozemenou et al (1997) highlighted some of the facilitators of and barriers to participation.
| Consumers | Carers | Staff/Management |
Resources |
Resources |
Structure and process |
Supportive group facilitator |
Supportive environment |
Knowledge and skills of consumers |
Wider supportive environment |
Knowledge and skills |
Support and resources |
Knowledge and skills of consumers |
Structure and forms |
Attitudes, commitment and responsivity of staff |
Attitudes and characteristics of consumers |
Attitudes of carers |
Responsibility on the part of consumers |
Issues specific to NESB |
Issues specific to NESB |
Issues specific to culture and ethnicity |
Table 1: Facilitators of and barriers to participation
(Source: Sozomenou et al., 1997). Weaving diverse partnerships: bringing together the threads of consumer and carer involvement
A lack of space in this issue precludes further discussion of strategies identified from the literature. However further discussion of consumer involvement will appear in June's issue of Auseinetter. Your suggestions and contributions would be welcomed!
References
Manderscheid, R.W., Pirkis, J. (1997). Evaluation of the National Mental Health
Strategy. Canberra: AGPS.
Donabedian, A. (1992). `Quality assurance in health care: consumers' role'. Quality in Health Care. 1:4, pages 247-251.
Draper, M. (1997). Involving consumers in improving hospital care: lessons from Australian hospitals. Health Services Outcomes Branch: Commonwealth of Australia.
Entwhistle, V. et al (1997). `Supporting consumer involvement in decision making: what constitutes quality in consumer information?' International Journal for Quality in Health Care. 8:5, pages 425-437.
Heaney, S. (1980). Preoccupations. London: Faber and Faber.
Hirschman, A.O. (1970) Exist, voice and loyalty: responses to decline in firms, organisations and states. Cambridge, Massachusetts: Harvard University Press.
Jones, A. & May, J. (1992). Working in human service organisations. Longman: London.
Ringma, C. & Brown, C. (1991). Hermaneutics and the social sciences: an evaluation of the function of hermaneutics in a consumer disability study. Journal of Sociology and Social Welfare. 18:3, pages 57-73.
Sozemenou, A., Mitchell, P., Fitzgerald, H.H., Malak, A. & Silova, D. (1997). Weaving diverse partnerships: brining together the threads of consumer and carer involvement. Proceedings of the 7th Mental Health Services Conference Inc of Australia & New Zealand (THEMHS).
Wilhite, B. & Sheldon, K. (1997). Consumer satisfaction for individuals with developmental disabilities. Activities, Adaptation and Aging. 21:3, pages 71-77.
For further information contact Ms Cathy Davis, Senior Project Officer, Auseinet, ph. 08 8357 5788, fax 08 8357 5484, email cathy.davis@flinders.edu.au: