Evaluations in Mental Health — Why They Matter for Justice, Quality, and Community Voice

From Institutions to Individuals: A Brief History of Mental Health Rights

In the mid-20th century, mental health care in the United States was dominated by large psychiatric institutions. People could be hospitalized involuntarily, often without opportunities to be heard or participate in decisions about their care. These were systems built on power, control, and exclusion. Over time, families, advocates, and activists began to challenge that reality — a movement that helped fuel the era of community mental health reform.

Early federal actions like the National Mental Health Act of 1946 helped shift focus from custodial institutionalization to research, treatment innovation, and community services, laying early groundwork for more responsive care systems.

Then, beginning in the 1960s and 1970s, the deinstitutionalization movement sought to move people out of state hospitals and into community-based care — a move rooted in recognition that long-term isolation did not serve people’s well-being and often caused trauma. Importantly, this period also coincided with broader civil rights movements, including the psychiatric survivors/consumer movements, where people with lived experience of mental health systems organized to demand rights, inclusion, and voice in how care was designed and evaluated.

 This context — a shift away from paternalistic systems toward models that value personal agency — helps explain why evaluations and user involvement in mental health services are so essential today: they are not bureaucratic checkboxes, but part of a long arc toward dignity and participatory care.

What Evaluation Has Historically Meant in Mental Health

Evaluation in mental health began largely as clinical and administrative measurement — tracking symptoms, outcomes, and service use. Over time, the focus shifted toward including the voices of those receiving care because they bring a perspective that purely clinical or administrative metrics often miss.

Research shows that including users in how services are evaluated isn’t just ethically good; it improves care. Studies have found that involving people with lived experience in the delivery and evaluation of services can be done safely and may lead to outcomes such as improved satisfaction and decreased hospitalization.

Other research points to how service user involvement changes care planning itself — when users are involved, the areas of focus often extend beyond clinical symptoms to address quality of life, everyday needs, and real-world concerns.

Evaluation as Accountability, Not Just Data

At Homeless Children’s Network, evaluation does three important things:

1. It holds us accountable to our community.

   Evaluation is fundamentally about respect. It says: As HCN’s Chief Operating Officer Dr. Kenneth Kim stated,

“We want to know what you think. Your experience matters.”

This is a rights-based approach that builds trust and centers the people we serve.

2. It guides ongoing learning and improvement.

   Basic satisfaction surveys can show gratitude, but they often don’t capture nuance — especially when people are navigating trauma, homelessness, and systemic barriers. That’s why HCN works with partners like Indigo Cultural Center to go deeper in how evaluation is designed and interpreted.

3. It reflects values of access, cultural sensitivity, and responsiveness.

   If evaluations feel tokenistic or extractive or like any other form, they don’t help anyone. But when they are crafted with attention to accessibility (kid-friendly language, culturally reflective tools, trauma-informed design), they become a means of mutual learning and respect.

Going Beyond the Scale: What Good Evaluation Looks Like

Research and best practices remind us that evaluations should be participatory and partnership-driven. There are many examples of positive user involvement:

• Users involved in research design and prioritizing topics

• People with lived experience participating in staff selection and training

• Service redesign efforts where user input led to meaningful operational changes

These examples show that when evaluation is built with users rather than done to them, it yields richer insights and often leads to services that are more responsive, humane, and effective.

HCN’s Partnership With Indigo Cultural Center

Our work with Indigo Cultural Center brings this philosophy into practice. Rather than outsourcing evaluation, we co-design surveys, focus groups, and interpretation with Indigo — a BIPOC-led evaluation organization grounded in community-based participatory research (CBPR). This approach honors context, culture, and relationship — not only what the numbers say. Together, we create evaluation tools that reflect families’ realities, innovate beyond standard scales, and make space for lived experience to shape what success means.

Evaluation Is Part of Justice and Healing

Ultimately, evaluation is an act of accountability and care — it ensures the people we serve remain at the center of our work. It reminds us that:

• Services should be shaped by people receiving them, not just administered to them,

• Data should be a tool for learning and action, not judgment, and

• Right to care includes the right to be heard.

As HCN’s own Data and Evaluations Coordinator, Sara Griffiths, explains:

“Conducting evaluation helps hold us as an organization accountable to our community. Receiving feedback from our community reinforces what we do well and opens our eyes to service gaps/needs… It supports an iterative learning process as we continue to evolve.”

Evaluation at its core is about recognizing humanity, listening deeply, and acting with integrity.