Community Mental Health Care Service

¶ … community mental health care service provision is often less effective than is necessary due to a breakdown in the communication between counselors and patient. I conducted research using an interview/questionnaire as my primary means of data collection, supplemented by a literature review. My research uncovered three significant findings. The first is that the most important factor in patient outcomes is the patient's level of medical literacy. The second is that language barriers are strongly correlated with negative outcomes in community care. A third issue that has been identified is the lack of training for communication. Case managers rely on experience to learn how to communicate with clients that have language barriers or low medical literacy. There is no formal training regimen that is undertaken in the profession however. The fourth finding is that many clients are not in any condition to be communicative, and that there is little counselors can do to enhance communication is this circumstance.

The patient's level of medical literacy can vary significantly in the community. There is concern that this level is going to decrease over time due to the increased complexity of the medical profession. Patients are unable to express to health care counselors what their problems are, and this complicates the process of determining diagnosis and treatment. Practitioners often find it difficult to make determinations based on the vague descriptions offered by patients with low medical literacy, indicating that there is a gap to be overcome.

The second finding is that language barriers are strongly correlated with negative outcomes in community care. In particular it was found in the literature review the language barriers impacted on the use of prescription medicines and that this had a significant impact on patient outcomes. As language is the building block of communication, community counselors should have access to translation services in order to better meet the needs of their patients.

The third finding is that there is little or no training provided to case managers with respect to overcoming communications barriers. Most case managers surveyed relied primarily on their experience or inherent interpersonal communication skills to convey information to clients. Those case managers with limited experience and/or weak interpersonal communication skills had the most difficulty. This is expected to correlate to poorer patient outcomes, so the training barrier is something that should be addressed at the systemic level.

The fourth finding is that some clients are not in any condition to be communicative. Often, these are the substance abusers or the mentally ill. There is little recourse for case managers to deal with these types of patients. The intoxicated are sent home if the situation is not an emergency, but beyond that there is little that the case manager can do to enhance communication with such individuals. The mentally ill, when not among the intoxicated as well, pose unique challenges of their own. Again, case managers often struggle to communicate with the mentally ill, in part because they do not always know if the client truly understands what it being communicated.

These findings highlight a number of issues that relate to the core problem of communication breakdown between counselor and client. There are a number of opportunities for communication breakdown. Unfortunately, any of them could result in negative patient outcomes. Thus, counselors need to be aware of these different points of breakdown. In addition, they need to be able to focus on overcoming these difficulties. For agencies, additional training can be useful for dealing with the mentally ill, the intoxicated and the medically illiterate. The availability of interpreters should be enhanced in some areas and should reflect the area's demographics. All of these recommendations flow from the research that was conducted both in the literature review and in the surveys given to case managers.

I believe this study does contribute to the broader knowledge of the subject. These issues are known in the profession, but it helps to bring them all together using an outcomes-based approach. This approach highlights that no matter the underlying reason for the communication breakdown, such breakdowns result in negative outcomes for clients. Practitiioners and agencies need to better understand the issues that they are faced with so that they can formulate better policy for dealing with issues of miscommunication. The results are consistent with the literature, and show that communication breakdown continues to be a problem that counselors struggle with. The lack of training and overreliance on experience, combined with the difficult of overcoming some of the communication barriers also contributes to the intransigence of this problem.

There are some areas for further study that flow from this research. One critical area of further study is with regards to training programs. Study on this subject should address each of the areas of miscommunication individually, and should focus on the effectivness levels of different types of training programs. Now that practitioners understand the nature of the problem, the time has come to focus on the development of best practices with respect to finding solutions. Some broader study should also be done on finding ways to reduce medical illiteracy. There are a number of options, including spending more time with clients discussing their situations, or presenting information online that can be referenced by patients to help them gain a better understanding. The effectiveness of these different educational techniques should be studied in order to determine best practices for overcoming this specific communication issue that crosses all lines of language and mental illness.

The Final Report

Abstract

This report focuses on the issue of communication breakdown between case managers and clients. There are multiple root causes of communication breakdown that are outlined. What they all have in common is that they lead to negative outcomes for the client. The paper also discusses some recommendations for overcoming these areas of communication breakdown and identifies areas where further research would be beneficial in addressing the serious health problem.

Literature Review.

Introduction

Caring for patients with mental illness can be a challenging endeavor. As a result of the challenge, it is vitally important that there is effective communication between counselors and patient within the context of the healthcare field. The purpose of this literature review is to explore effective communication between counselors in patient health care.

Literature Review

Effective Communication in the treatment of patients is vitally important to ensuring that patients have good outcomes. As article entitled: Counseling patients with low Health Literacy "points out the importance of counseling patients in the sphere of healthcare.

This particular article establishes the need for clear communication especially for those with limited health literacy. The article reports that communication between health counselors and patients is often ineffective because the average patient does not understand the medical terms that are often used (Nielsen-Bohlman et al., 2004)

The article reports that the health literacy of the patient will determine the manner in which the patient is counseled. The article defines health literacy as the capacity to read health care information and also the ability to apply the information to the specific medical condition that the patient is confronting. The article also explains that healthcare counselors such as case managers, health caregivers, nurses, physicians, pharmacist and other health care personnel often speak in medical terms not understood by many patients. Having been educated in the meaning of these terms and using them every day, health care personnel forget to use lay terms when speaking to patients with growing awareness, attention is being focused on communication skills training during the formal education of health care professionals (Hardin, 2005).