Consumer Quality Initiatives (CQI) is an effective consumer research voice regarding mental health care in Massachusetts, primarily through assessments of consumer satisfaction and perceptions of quality, including for people who are homeless. Since its beginning in 1999, CQI has had a contract with the Massachusetts Behavioral Health Partnership (MBHP), the state Medicaid behavioral health managed care company, to conduct interviews with MassHealth [Medicaid] recipients about their satisfaction with a variety of behavioral health programs and services. CQI has developed specific surveys for adult inpatient psychiatric, dual diagnosis care, outpatient clinical care, and day treatment services, and has used those instruments to interview close to 2000 MassHealth recipients.

CQI works with academia to train consumers to conduct research, and with consumers to train academia on their perspective of mental health services. Its community-based research approach has challenged prevailing methods of academic mental health research. CQI uses Community-Based Participatory Action Research, a collaborative process to involve all partners in the research process and recognizes unique strengths. CQI sees its mission and objectives as directly responsive to the 2003 President's New Freedom Commission report's call for a consumer-driven mental health system of care, with a specific reference to consumer led research and evaluation.

CQI consumer interviewers are highly trained to conduct face-to-face interviews and focus groups, and as consumers, are best able to establish a strong rapport with those being interviewed. CQI believes that personal interviews are especially important for people who face barriers in bringing their experiences and views forward, are disenfranchised, and have not historically been encouraged to think critically and/or creatively about their care.

The Massachusetts Department of Mental Health and MBHP have contracted with CQI to conduct personal interviews and focus groups on consumers' experiences with mental health services in the state system. CQI collects a wide range of data - largely comprised of personal information that is generally difficult to obtain from mental health consumers - and delivers the results to service providers in the form of in-depth reports, which are then used to help improve services. CQI also works with DMH, the Partnership and providers to transform its findings into practice and policy statewide. Each of CQI's 10 staff members and a majority of its Board either live with or are recovering from some form of mental illness or are significantly involved in the life of someone with a mental health condition.

Individuals experiencing homelessness and living with mental health issues benefit by being engaged as partners to their own recovery and expressing their preferences for treatment, housing, and employment.

Treatment facilities benefit by learning the experiences of consumers who otherwise would face barriers to having their views heard.

Public and private sector partners benefit by learning from the consumer what is working and what is not, so that partners such as MBHP can learn more about how to sustain individuals successfully in the community and utilize peer partners.

Policymakers benefit by hearing credible research and results from experienced researchers with unique access to consumers.

A recent CQI Issue Brief - Homelessness And Psychiatric Hospitalization: The Experience Of Adult MassHealth Recipients - provides insight into findings regarding the experiences of homeless MassHealth recipients who are patients in Massachusetts psychiatric inpatient units. It is an example of the quality of work and usefulness of CQI research and provides some suggestions for addressing the problems faced by homeless consumers. Studies have demonstrated that people with mental health disorders who are homeless "can be engaged in services, can accept and benefit from . . . services, and can remain in stable housing with appropriate supports." Nevertheless, according to the federal government many people who are homeless qualify for mental health services but do not access them. Even when such services are accessed, they often fail to meet the special needs of people who are homeless. As a result, many homeless people cycle between the streets, acute care settings, and jail at enormous personal cost as their homelessness and vulnerability continues, and at great public expense in acute care systems.

Findings and recommendations based on the engagement of consumers by other consumers and family members provide detailed and quality insight into barriers and challenges as well as unmet need. Housing is a priority issue for consumers, and CQI survey respondents using inpatient services were much more likely to be homeless compared to those using outpatient services, such as clinics and day programs.

For example, the brief cited above identified that, while the demographics of homeless and non-homeless consumers were comparable, people without stable housing were relatively less satisfied in almost all aspects of their inpatient care/treatment. Homeless patients were significantly less likely to report improvements in their condition since they were admitted to the hospital. Lower levels of improvement are indicators of a greater likelihood of re-hospitalization and other problems.

Homeless respondents were significantly less satisfied with staff's efforts to prepare them to access aftercare services. Just over one-half (56%) of the homeless respondents were satisfied with efforts to help them find housing.

Jonathan Delman is the Founding Executive Director of CQI and a Massachusetts mental health activist who lives with bipolar disorder. He was co-chair of the President's New Freedom Commission work group on quality measures and information technology for acute care.

Mr. Delman was named in 2008 by the Robert Wood Johnson Foundation as one of ten exemplary Americans to receive the Community Health Leaders Award for 2008. According to the citation, under his leadership, CQI has created opportunities to involve people with mental illness in a meaningful way all aspects of mental health research, systems planning, and program evaluation. The organization has been innovative in establishing mechanisms for academia and the consumer community to work together to develop research projects that are relevant to the community and impactful on policy and practice. Mr. Delman and his work also challenge the stigma that people with mental illness cannot engage in a recovery process, handle responsibility and be productive members of society.

State partners, including the Department of Mental Health and Massachusetts Behavioral Health Partnership, have created an expectation of consumer partnership and credible sources of consumer insight against which to evaluate public programs.

Learn more about CQI and its work: Visit the CQI web site at http://www.cqi-mass.org or email CQI at info@cqi-mass.org

Learn more about the President's New Freedom initiative at the New Freedom Commission web site: http://www.cms.hhs.gov/NewFreedomInitiative/

Learn more about the Massachusetts Behavioral Health Partnership at: http://www.masspartnership.com/index.aspx

Learn more about the Massachusetts Interagency Council and the Department of Mental Health and its initiatives for consumers and individuals who are homeless: www.mass.gov

08 in 08, continues with a Special Issue focused on . . . Building Tulsa, Building Lives: A public-private partnership, with roots in creating community integrated housing opportunities for persons with mental health disabilities, is creating permanent supportive housing using a debt-free, mixed income, mixed population model that promotes sustainability . . .

Don't miss a single episode during this 08 in 08 Innovation series . . . but, if you do, you can always access the Council's "on demand" service and catch up. Just visit our web site at www.usich.gov/innovations. You can also see the Council's previous Innovations series - 20 in 20 and 5 in 5, all profiles of what's working to end homelessness.

email: usich@usich.gov

web: http://www.usich.gov