OBJECTIVE: In 1988 Vermont implemented a policy designed to reduce the
state hospital census and expand community-based services. This qualitative
study assessed perceptions of the policy's impact among mental health
consumers, family members, and providers. METHODS: Eleven focus groups were
convened, which included 94 participants from across the state. Separate
groups were held for consumers, family members, and providers. Trained
facilitators guided discussion of the policy's effect on quality of life,
housing and vocational status, community integration, and social networks.
Audiotapes of the discussion were transcribed, and content was analyzed.
RESULTS: Several universal themes were noted. All participants reported
that stigma was still a substantial barrier to integration and that
community education to reduce stigma had not been effective. Tension
between families and providers was a problem; family members felt that
although providers depended on their supporting the consumer, they were not
included in treatment planning. All participants noted that urban areas
were better served by the policy's service packages. A lack of coordination
of community services was reported to be a continuing problem across the
state. In contrast to findings of previous studies, consumers in this study
preferred not to live alone, which led to feelings of isolation.
CONCLUSIONS: Service delivery in rural areas and system coordination
throughout the state must be improved. Families' conflicting feelings of
burden and isolation must be addressed. Further research should determine
more clearly the range of housing preferences among consumers.