Objectives This study investigated whether patients’ satisfaction with their mental health care and quality of life is related to their age, gender, psychiatric diagnosis, and duration of mental disorder. Method 120 adults of working age who were receiving input from a community mental health team in North Yorkshire were invited to complete the Carers’ and User’s Expectations of Services, User Version (CUES-U) questionnaire. This 16 item self rated outcome measure covers the issues that those using mental health services have identified as being their priorities. Results CUES-U ratings were lowest for “Social life” (49% satisfied) and highest for “Relationships with physical health workers” (88% satisfied). Satisfaction with psychiatric services correlated significantly with patients’ age (Spearman’s r = 0.444, p<0.001) and their satisfaction in other areas of their lives such as housing, money, and relationships (r = 0.575, p<0.001). Those with psychotic disorders rated their quality of life as higher than other respondents (median total satisfaction score 12 v 9, Mann-Whitney U = 377, p = 0.001). Gender and duration of disorder were unrelated to service satisfaction. Conclusions Patient satisfaction ratings have been promoted as an outcome measure when evaluating the quality of their mental health services. Certain factors influencing an individual’s satisfaction with the care provided (such as their age and general quality of life) are not directly under the control of professionals.

The transfer of knowledge occurs most effectively through the stories -the narratives -that we tell others and ourselves about our experiences. Cognitive behaviour therapists may incorporate stories, metaphors and analogies within their daily practice, when assessing suitability for treatment, challenging unhelpful styles of thinking, and addressing maintaining behaviours. The collaborative development of stories can enhance rapport, enable clients to gain a new perspective upon their problems, increase personal impact and clarity of meaning, and reinforce clients' motivation to effect therapeutic change. This paper discusses the use of the story, anecdote, metaphor, analogy, and quotation within cognitive behaviour therapy (CBT). The contribution of other psychotherapies to these forms of therapeutic communication is outlined. Practical examples of stories and analogies that illustrate the main principles of CBT and its application to the treatment of common mental disorders are described. The benefits and limitations of employing individualized analogies and stories within the therapy session are highlighted.

Repeated self-harm without suicidal intent occurs in approximately 2% of adults (Meltzer et al, 2002). Service users report that professionals can respond to self-harm with unhelpful attitudes and ineffective care. Although evidence for effective treatments is poor (Hawton et al, 1999), this therapeutic pessimism is not found in the self-help approaches promoted by voluntary organisations such as Mind: ‘If you feel the need to self-harm, focus on staying within safe limits' (Harrison & Sharman, 2005). User websites frequently offer advice on harm minimisation: ‘Support the person in beginning to take steps to keep herself safe and to reduce her self-injury – if she wishes to. Examples of very valuable steps might be: taking fewer risks (e.g. washing implements used to cut, avoiding drinking if she thinks she is likely to self-injure)’ (Bristol Crisis Service for Women, 1997).

SummaryEighty patients aged 75 years and over were interviewed in the surgery or at home to assess their level of knowledge, degree of compliance, and problems with their medicines. Regular medication was prescribed to 59 patients, who took a total of 206 drugs. The correct purpose of medication was stated in 72% of cases, the dosage regimen recalled accurately for 75%, and the correct name given for 64% of drugs. The elderly rated their compliance as 'good' (never miss doses) for 77% of drugs prescribed. This correlated poorly for individual patients with the level of correct compliance as assessed on computer records of repeat prescriptions, which nevertheless was accurate for 80% of medicines taken. A significant difficulty for the elderly was the removal of tops from medicine containers, occurring in 18 cases (31% patients), including half of those taking analgesics or nonsteroidal anti-inflammatory drugs. The widespread, legally enforced, use of childresistant containers for the elderly frequently seems inappropriate. Further improvements in comprehension and compliance may occur with regular explanation and rationalisation of medication by the family doctor, when visiting the elderly at home.

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