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An examination of differences in outcome priorities among stakeholders in community-based services for seriously mentally ill adults

John E Brelsford, University of Massachusetts Amherst


This study examined whether the concept of desired outcome in community programs serving adults with psychiatric disorders was a unitary or multifaceted concept and whether, if multifaceted, subject stakeholder group membership or variables of sex, education, age or attitudes were related to subject preferences for types of outcome. A literature review and focus groups were used to establish a broad range of potential outcomes and 47 subjects from six stakeholder groups (clients, family members, direct care staff, directors of programs serving clients with serious psychiatric disorders, DMH personnel who made service funding decisions, and taxpayers) sorted the 82 outcomes in order of their perceived importance. Subject responses were factor analyzed and a five factor solution was interpreted as indicating concerns for (1) increased client self determination, (2) risk reduction and stability, (3) provision for basic needs, (4) increasingly responsible and integrated community living, and (5) increased autonomy through skill development and symptom reduction. Stakeholder group membership was the only subject variable significantly correlated with subject differences in loading on the five identified factors. It was concluded that these differences had important implications for the ability of stakeholder groups to interact productively. That is, if individuals with differing views on the proper goals of the community mental health system fail to understand the nature of their differences conflict and distrust will continue and a coherent sense of mission for the community system will be impossible to attain. The author asserts that it is important for stakeholders to recognize the legitimacy of, and basis for, the views of others with whom they are attempting to work. Steps recommended to use these findings to improve the quality of practice in the field include: acknowledgment of conflicts inherent in differing points of view, clarifying the extent to which custodial care and social control of those with psychiatric disorders are primary functions of the community system, resolution of legal and ethical issues inherent in "ensuring" the care and safety (as defined by others) of those with psychiatric disorders, specification by funders of outcome priorities, and greater use of outcome measurement in program evaluation.

Subject Area

Mental health|Social work|Psychotherapy|Health care

Recommended Citation

Brelsford, John E, "An examination of differences in outcome priorities among stakeholders in community-based services for seriously mentally ill adults" (1996). Doctoral Dissertations Available from Proquest. AAI9709576.