A quality of life theory is proposed as a framework for conceptualizing and evaluating mental health services. Quality of life consists of fulfilling needs, meeting social expectations, and accessing opportunities by using abilities. Abilities are impaired by mental illness. Mental health services moderate social demands, supplement opportunities, and restore abilities. A 263 item questionnaire was developed to assess the impact of mental health services on clients'' quality of life. A 24 site study including 1,154 pre-tests, 758 post-tests, and 190 interviews with randomly selected community residents was conducted. Evidence for the reliability and validity of the questionnaire are presented. The instrument discriminates among four known client groups, client and community samples, communities with known quality of life differences, and pre- versus post-treatment samples of clients. The convergence between client''s retrospective impressions of improvement and measured pre-post improvement is discussed.
The data collection was supported by National Institute of Mental Health contract 278-79-0053(OP), Enid Light, project officer, and Cecil Wurster, adviser, both contributed greatly to this work. The writing of this paper was supported by National Institute of Mental Health grant MH43458-02.