Outcomes in the community care community mental health care quality of life and the perspective of service users a comparative study in Scotland and Germany

Abstract

This thesis examines the effects of community mental health care on the quality of life of mental health service users in Britain - especially Scotland - and Germany. The analysis is based on current developments in community care policy and practice in the countries of comparison and the perspective of mental health service users in relation to this. The research strategies adopted include qualitative and quantitative methods, in particular a questionnaire survey among mental health service users in Scotland and in Germany. The examination of outcomes in community care with a specific focus on the concept 'quality of life' shows that quality of life is useful as an outcome measure for the comparative evaluation of community care from a user perspective. The study develops a model of quality of life which highlights significant components of community care identified as health, housing, employment, finances, support and social contacts. The examination of some of the foundations of health care and social care in Britain and in Germany, and the comparison of specific mental health care policies and legislation emphasise distinct national characteristics and fundamental differences concerning themes and issues in mental health care. Most significantly, the analysis shows a different national emphasis on major policy objectives and concepts such as quality of life or on the role of the service user. Furthermore, the examination of significant components of community care shows how different national policies can affect support options and general availability in community mental health care. The analysis of the views of mental health service users indicates that their quality of life is directly affected by specific national developments and different national approaches in mental health care. This concerns the availability (or absence) of different support options, but also the role of service users as participants in service provision (Scotland) or rather as recipients of service provision (Germany). The comparison of different national support options and the analysis of user views in relation to this highlights specifically positive and negative effects on the quality of life of mental health service users. Most appreciated by service users are support options that provide opportunity for choice, independence, personal autonomy and fulfilment. The study shows that community based service provision and especially professional support is extremely important to mental health service users and has a direct and vital impact on their quality of life.