Journal of Psychiatric and Mental Health Nursing, 2004, 11, 292–297 292 © 2004 Blackwell Publishing Ltd HANSEN T., HATLING T., LIDAL E. & RUUD T. (2004) Journal of Psychiatric and Mental Health Nursing 11, 292–297 The user perspective: respected or rejected in mental health care? The purpose of this study was to examine the extent to which patient views influence treat- ment planning by measuring the level of agreement between patients and health workers regarding patient needs as well as the impact of patient wishes on decision making when viewpoints conflict. Data on patient characteristics and needs were collected for a sample of 1080 patients within Norwegian mental health care using patient interviews and health worker ratings. Results of the assessment were then reviewed by multidisciplinary treatment teams responsible for making decisions regarding patient needs for services. On average, patients, health workers, and teams identified 4.3 (SD = 4.2), 9.3 (SD = 5.5), and 10.3 (SD = 5.7), respectively, of 40 possible needs per patient. In cases where patient and health workers disagreed on the presence of a need, the teams tended to concur with the health worker. Interestingly, health care workers and teams were far more inclined than their patients to identify needs related to professional monitoring and follow-up. Results may indicate that contemporary tenets in mental health care regarding user involvement and autonomy are not sufficiently emphasized in practice. Keywords: autonomy, empowerment, mental health care, need assessment, Norway, pro- fessionals, psychiatry, user involvement Accepted for publication: 18 November 2003 et al. The user perspective: respected or rejected in mental health care? T. HANSEN 1 , cand. polit(psychology), T. HATLING 1 , RN cand. polit( S ociology), E. LIDAL 2 , RN & T. RUUD 3 , MD P h D 1 Researcher, 2 Project Manager and 3 Research Director, Department of Mental Health Services Research, SINTEF Unimed, Trondheim, Norway Correspondence: Thomas Hansen NOVA Pb. 3223 Elisenberg 0208 OSLO Norway E-mail: han@nova.no Introduction Empowerment and user involvement are important tenets of contemporary mental health care. Attributes of these concepts include mutual decision making, patients’ right to choose, and respect and valuation of the patients’ view (Rodwell 1996, Woodward 1998). The stated core objec- tives embodied in the Norwegian Parliament’s White Paper no. 25, Openness and Comprehensiveness, emphasize pro- fessional encouragement in promoting user participation and that patient viewpoints should be taken into account when making decisions regarding services. The Patient Rights Act of 2000 requires health care professionals to include patient participation in service planning. Similar user involvement policies and legislations also exist in the UK and other countries (Hickey & Kipping 1998, Leese et al. 1998). The question remains whether new policies surrounding user participation and self-determination have led to sig- nificant alterations in practice (Rudman 1996, Poulton 1999, Lammers & Happell 2003). It is argued that to date, professionals are unwilling to contemplate sharing power with the patient and that the view ‘professionals know best’ still prevails (Myers & MacDonald 1996, Forbes & Sash- idharan 1997, Hickey & Kipping 1998). In contrast, some fear that the new developments and the stigma of paternalism will lead to an overemphasis on patient autonomy, which may suppress beneficent interven- tion (Breeze 1998, Woodward 1998, Verkerk 1999). For patients with profound mental problems, paternalistic deci-