Patterns of Discord:  Goals of Patients, Therapists, and Community Members

A BASIC assumption in hospital psychiatry is that the patient and his therapists work toward the same treatment goals. This assumption has far-reaching implications because both the practice of hospital psychiatry and the design of research to evaluate hospital programs are based primarily on the values of clinicians.

Clinicians believe that patients are admitted to psychiatric hospitals primarily because they are mentally ill. The hospital's treatment program is designed to treat the mental illness of patients so that they can return as soon as possible to productive community functioning. In order to evaluate the effectiveness of psychiatric hospitals the researcher first obtains, from the hospital administration, clear, concise statements about the goals of the hospital. He then translates these statements into quantifiable outcome criteria, which are applied to patients at various points in their hospital and posthospital careers, so that hospital programs can be compared and evaluated.¹ Since they