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This Web site is a component of the SAMHSA Health Information Network. |
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Community SupportA Tale of Two Networks: Possibilities and Perils for Mental Health Internet Discussion Groups Results
Original Goal of List The purposes of each of the lists that were part of the Topical Evaluation Network program were described briefly in an informational brochure published by the Evaluation Center@HSRI. The purpose of OUTCMTEN was described as, "to develop a broad collective expertise with respect to problems of assessing and analyzing outcomes of interventions aimed at improving mental health systems." The Evaluation Center brochure described the purpose of LEGALTEN to be "to facilitate the implementation and use of rigorous evaluations at the interface of the mental health system, the criminal justice system, and the courts." Membership List members were encouraged to introduce themselves and describe their interest in the issues of the list. Not all list members did introduce themselves, however, and no systematic analysis of the introductions that were posted was conducted. A discussion of the differences in list membership based on the authors' impressions is included in the Discussion section. Reasons for Subscribing and Continued Membership OUTCMTEN From the archives, the reason for subscribing to OUTCMTEN cited most by participants was to discover the issues related to, and interact with the key figures in, the area of program evaluation in mental health. In general, through a discussion with a variety of stakeholders, they expected to get information on methods for measuring outcomes for behavioral health care programs or services. For some, their expectations were only partially met, while for others, they were exceeded. "As with any of these networks," explained one respondent, " the wheat-to-chaff ratio is pretty small. The extremely wide range of participants has been interesting sometimes, but has led to discussions that are irrelevant to me at other times." Another subscriber, impressed by how the list helped him work more efficiently, commented, "I got even more than I anticipated. The rapid responses helped shape my opinions and direct some of my work more quickly than would have been possible in any other way given the large numbers of states involved with this type of work." LEGALTEN Participants originally subscribed to LEGALTEN for the chance to discuss and learn about evaluation issues at the intersection of mental health care and the law. Ultimately, however, list members focused not on evaluation, but instead the value issues underlying the relationship between mental health care and law. Content OUTCMTEN The discussions on OUTCMTEN were very specific to evaluating outcomes in the mental health field. Towards the end of March, one participant summarized the discussions that were taking place and thanked those who were participating in them. In the words of his message, topics of discussion included:
The discussion on OUTCMTEN about values was limited to two participants and lasted a single day. The values discussion arose when a subscriber of OUTCMTEN questioned an assumption stated by another participant in his introduction. The discussion was brief and concise apparently because the participants shared the same basic beliefs. LEGALTEN Most of the discussions on LEGALTEN, focused on the values and beliefs of the participants. The subject matter was a great deal more controversial and personal and there was a greater heterogeneity among the participants with respect to their views on the subject matter and their communication norms. Topics discussed included involuntary treatment, electroshock therapy, the use of long term, forced neuroleptic medications, and isolation. This led to many more conflicts, many of which never were resolved and/or escalated into personal attacks. Thus, on LEGALTEN, there was a much greater need for negotiation skills for consensus building or conflict resolution than on OUTCMTEN. Patterns of Participation OUTCMTEN Number of messages and participants During 1995, 1277 messages were posted on OUTCMTEN. An average of 3.5 messages were posted each day, with a standard deviation of 4.37. An average of 3 subscribers posted messages each day, with a standard deviation of 3.55. The number of active participants in OUTCMTEN made up between one and two percent of the total subscribers to the list. There was a gradual increase in total subscribership during the period in which data were collected. The average number of subscribers during the 1995 period was 418. It was not common for participants to post more than one message a day. In 1995, for example, there were only nine days when one or more individuals posted two or more messages. On only one day did the average number of messages posted per participant exceed two. The textual data show that this occurred when a new participant introduced himself and was then questioned by a psychiatric survivor regarding an assumption in his introduction. As a result of their ensuing conversation, which lasted only one day, the new participant posted three messages, and the psychiatric survivor two. An examination of the distribution of messages per day with the number of messages posted per participant per day reveals that there is no apparent correlation between periods of high message frequency and periods of high participation. Only once does a period of high message frequency coincide with high participation. This occurred between February 6 and April 7. Tone In general, participants would thank others for information, give positive reinforcement to questions, and when disagreeing with a point, emphasize that their comments were meant to be constructive. For example, after writing a message questioning the robustness of a measurement scale, a participant wrote: "In case this comes out sounding harsh (which some of these communications do, inadvertently) I am in no way challenging or disputing your scale; I am just trying to generate further discussion." The discussions on OUTCMTEN were highly focused. OUTCMTEN functioned as intended; as a forum for discussing the evaluation of outcomes in the field of mental health. Discussions were about technical issues and attracted subscribers who shared the same basic assumptions, experiences, and communication styles. LEGALTEN Numbers of messages and participants The total number of messages posted to LEGALTEN during 1995 was 1473. An average of 4 messages were posted per day, with a standard deviation of 5.96. There were three distinct periods of activity during 1995: the first in early January, the second during March, and the third between June and August. After the third period concluded, there were almost no messages posted on LEGALTEN. An average of 2.7 subscribers posted messages each day, with a standard deviation of 3.4. On LEGALTEN, about one to three percent of the total subscribers were active participants. In 1995, there was a sudden jump in subscribership during the beginning of March (this was when the list was announced on America On-line) but then a gradual decrease in membership during the final period of heavy activity between June and August, possibly reflecting the frustration of several list subscribers with the direction LEGALTEN was going in. The average number of total subscribers to LEGALTEN during the period in which data are available was 298. Tone Discussions on LEGALTEN tended to be more wide-ranging and intense than discussions on OUTCMTEN. It became a forum for discussing values as well as evaluation at the intersection of the mental health and criminal justice systems. It attracted participants from a variety of backgrounds, experiences, and communication styles. Participants on LEGALTEN seemed to be more caught up in expressing their points of view, rather than engaging in a dialogue. Instead of directing their efforts to understanding and being understood, many participants limited themselves to repeating their own positions and criticizing others. The confrontational tone of much of the discussion on LEGALTEN is indicated by the relatively high occurrence of the word "you." During 1995, there were 2467 occurrences of "you" on LEGALTEN, 114 percent more than for the same period on OUTCMTEN. "One of the things that LEGALTEN did was really level the field," explained the Chair. "Everybody had their say, everybody had a chance to finish their thought as best they could, nobody had really any particular advantage over anybody else. Credentials, degrees, and positions and all those kinds of things really didn't matter as long as people could make their point." Modes of Expressing and Managing Conflict OUTCMTEN In all of 1995, there was only one period when a discussion about the tone of OUTCMTEN took place. However, the issue of tone did not ever escalate into conflict. The participants did not use personal attacks, or intense language to express their points and alternate points were recognized. The tone issue was dropped altogether and not brought up again. As will be shown, this same issue was handled quite differently on LEGALTEN. LEGALTEN On LEGALTEN, the language was a great deal more intense and extreme and at times could have been interpreted as a shouting match. Those who were unhappy with the tone of the list noted that it had become a "flame war," "an argument that never will be won," "a series of rants and name-calling," "talk-radio," passionate, political, and a "slanging match." On OUTCMTEN, with the exception of two posts, the exchange of messages in question was simply referred to as a "discussion." The Role of the Chair OUTCMTEN During the time period examined, the Chair of OUTCMTEN participated once in a discussion regarding health insurance. His post generated several other messages both agreeing with and challenging some of his points, and these developed into a discussion on financial incentives in the mental health care system. LEGALTEN The Chair of the LEGALTEN Network was interested in finding out about any new and important developments in the area of criminal justice and mental health (such as civil commitment) at the state and county level. He viewed the LEGALTEN Network as a way to be connected to people at those levels and to find out what exactly was happening there. Additionally, he viewed it as a way for the Evaluation Center, which sponsored the Topical Evaluation Networks, to gather data concerning evaluation technical assistance needed by persons working at the interface of mental health and the law. The chair of LEGALTEN imagined "a bunch of lawyers and psychiatrists and maybe mental health agency people talking with each other" collegially, "but it never happened." At first, he tried to respond to what people were saying on the list, but soon, found that he couldn't keep up and, as he described it: The whole thing got away from me ... what I envisioned this being and what it became were really very different ... There was much more consumer and advocacy involvement than I thought there would be. On the other hand, I by no means regret that. I think it really enlivened the discussion. I learned a lot from it. I hope others did too, if they took it in the spirit that this is finally an opportunity to hear everybody's voice (Fisher, 1996). Summary Table 2 presents a summary of the findings of our analysis. While the two lists were both designed to foster discussion about issues related to mental health services and systems evaluation, the lists evolved differently in terms of content and patterns of participation. The discussion on OUTCMTEN was more focused on its original topic while LEGALTEN gravitated towards discussion of the value of mental health treatment, a subject only somewhat related to the original goals of the list. Participation on LEGALTEN was more frequent and contained more instances of multiple postings per day by individual members, when compared to OUTCMTEN. The most marked differences may have been in the content and tone of the discussions: OUTCMTEN participants predominantly discussed technical issues in a manner that facilitated discourse and learning while LEGALTEN discussion was dominated by heated debates and attacks that led many members to leave the list.
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