ORIGINAL RESEARCH

Consumer Satisfaction With an
Adolescent Inpatient Psychiatric Unit
Keith Marriage, MD, FRCPC1, Julie Petrie, MEd2, David Worling, PhD3

Objectives: To explore factors influencing the satisfaction of patients, parents, and referring clinicians who used the services of an adolescent inpatient psychiatric unit, and to explore how levels of satisfaction related to the patient’s symptomatic and functional improvement during the admission.
Method:  All 105 adolescents, their families, and the referring community clinicians who used an inpatient service over a 1-year period were asked to rate the patient’s symptoms and functioning on admission, at discharge, and 4 months after the patient’s return to the community. We obtained satisfaction ratings at discharge, and consumers were asked to rate helpfulness of the ward experience at 4 months postdischarge. Ward psychiatrists provided Children’s Global Assessment Scale (CGAS) ratings and diagnoses over the course of the inpatient stay.
Results:  Most of the patients (83%) improved during their admission. Consumer satisfaction ratings correlated with improvement of self-identified problems and with the perceived usefulness of discharge recommendations. Satisfaction did not, however, correlate with the patient’s symptomatic and functional progress. Interaction with ward staff was an important source of both positive and negative experiences.
Conclusion:  Our study indicates that inpatient psychiatric staff should attend closely to the consumer’s perception of difficulties and the need for practical discharge recommendations.

(Can J Psychiatry 2001;46:969–975)

Key Words:  adolescent psychiatric inpatient unit, clinical outcome, consumer satisfaction


As community advocacy groups and funding agencies increasingly influence health care policy, it is important to include the consumer’s viewpoint in any evaluation of mental health services. Many outcome studies involve medication or psychotherapy trials, and follow the client according to the clinician’s diagnostic criteria and evaluations (1). These studies, however, fail to address consumers’ perception of how much they were helped by the treatment (2) or the question of the overall usefulness of a service to its various clients.

When evaluating psychiatric programs, consumer satisfaction is a legitimate indicator of the quality of service provided and an important outcome measure (2–4). In addition, it helps to address the need for increased accountability and quality assurance for funding agencies (2,4–8). Input from patients may also contribute to changing practices in mental health facilities (9,10).

Several authors (2–4,7,11) have reviewed the literature on satisfaction with mental health services and report overall satisfaction ratings that range from 58% to 98% (12,13).

Manuscript received and accepted June 2001.
1Director, Post Graduate Child Psychiatry, Training, Department of Child and Adolescent Psychiatry, Children’s and Women’s Health Centre of British Columbia, Vancouver, British Columbia.
2Psychometrician, Department of Psychology, Children’s and Women’s Health Centre of British Columbia, Vancouver, British Columbia.
3Psychologist, Department of Psychology, Children’s and Women’s Health Centre of British Columbia, Vancouver, British Columbia.
Address for correspondence:  Dr K Marriage, Department of Child and Adolescent Psychiatry, Children’s and Women’s Health Centre of British Columbia, 4480 Oak St, Vancouver, BC V6H 3V4
e-mail: kmarriage@cw.bc.ca

These reviewers, however, emphasized methodological difficulties, including low rates of return, increased response by the more satisfied clients, varying results depending on the end point at which sampling was carried out, and the differing perceptions of various consumer groups.

One might expect consumer satisfaction to increase with the degree of the patient’s recovery; instead, the findings on this question have been equivocal. In the adult literature, Eyers and others (8) found a modest positive association between patient and referring clinician satisfaction and patient clinical recovery, as did Deane (14) between the therapist’s rating of patient improvement and client satisfaction. Others report minimal or no relation between satisfaction ratings and changed psychopathology (15,7).

In child and adolescent studies, Rey and others (16) found a modest concordance between parent satisfaction and the treating clinician’s positive outcome rating of the consultation. Bradley and Clarke (17) found that parents who perceived that home-based problems had improved were more satisfied with their child’s inpatient treatment. In 2 thorough evaluations of a comprehensive multimodal treatment program, however, Heflinger and others (13) and Lambert and others (2) did not find that satisfaction varied with clinical outcome. In fact, Lambert and others concluded that for their study population, consumer satisfaction was unrelated to symptom change.

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