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Background  Health systems increasingly try to make their services more responsive to users' expectations. In the context of the World Health Report 2000, WHO developed the concept of health system  responsiveness  as a performance parameter.  Responsiveness  relates to the system's ability to respond to service users' legitimate expectations of non-medical aspects. We used this concept in an effort to evaluate the performance of mental health care in a catchment area in Germany.    Methods  In accordance with the method WHO used for its  responsiveness  survey,  responsiveness  for inpatient and outpatient mental health care was evaluated by a standardised questionnaire.  Responsiveness  was assessed in the following domains:  attention, dignity ,  clear communication ,  autonomy, confidentiality, basic amenities, choice  of health care provider,  continuity , and  access to social support . Users with complex mental health care needs (i.e., requiring social and medical services or inpatient care) were recruited consecutively within the mental health services provided in the catchment area of the Hanover Medical School.    Results  221 persons were recruited in outpatient care and 91 in inpatient care. Inpatient service users reported poor  responsiveness  (22%) more often than outpatients did (15%); however this was significant only for the domains  dignity  and  communication . The best performing domains were  confidentiality  and  dignity ; the worst performing were  choice ,  autonomy  and  basic amenities  (only inpatient care).  Autonomy  was rated as the most important domain, followed by  attention  and  communication .  Responsiveness  within outpatient care was rated worse by people who had less money and were less well educated. Inpatient  responsiveness  was rated better by those with a higher level of education and also by those who were not so well educated. 23% of participants reported having been discriminated against in mental health care during the past 6 months.  The results are similar to prior  responsiveness  surveys with regard to the overall better performance of outpatient care. Where results differ, this can best be explained by certain characteristics that are applicable to mental health care and also by the users with complex needs. The expectations of  attention  and  autonomy , including participation in the treatment process, are not met satisfactorily in inpatient and outpatient care.    Conclusion   Responsiveness  as a health system performance parameter provides a refined picture of inpatient and outpatient mental health care. Reforms to the services provided should be orientated around domains that are high in importance, but low in performance. Measuring  responsiveness  could provide well-grounded guidance for further development of mental health care systems towards becoming better patient-orientated and providing patients with more respect.

bmc health services research

How does mental health care perform in respect to service users' expectations? Evaluating inpatient and outpatient care in Germany with the WHO responsivenessconcept