Measuring or Meaning? Insights into Quality of Mental Healthcare from Patient and Therapist Stories

Background Routine Outcome Monitoring (ROM) was introduced in Dutch mental healthcare to enhance transparency, accountability, and quality. However, questions remain as to whether such standardized, symptom-focused tools capture what patients and therapists themselves perceive as quality. This study explores how both groups define good care and considers how these understandings relate to existing measurement frameworks. Methods A qualitative, inductive thematic analysis was conducted on 50 patient narratives from the Dutch Psychiatry Story Bank and 52 therapist narratives drawn from two professional anthologies ( Therapists Share and The Soul of the Craft ). An iterative coding process was used to identify recurring patterns in how quality of care is described across both groups. Results Both patients and therapists portray mental healthcare as a long-term, meaning-making process embedded in personal and relational contexts. Across narratives, six interrelated components of quality emerged: (1) the therapeutic relationship, (2) insight and coping, (3) change in symptoms, (4) life outcomes, (5) integration of care into everyday life, and (6) systemic fit. Rather than representing separate domains, these components can be understood as different expressions of relational quality. While both groups emphasize relational and contextual aspects of care, they also describe tensions arising from systemic and institutional constraints, as well as differences in how care processes are experienced and enacted. Conclusions The findings suggest that standardized outcome measures such as ROM capture certain aspects of care, particularly symptom change, but only partially reflect the relational and contextual processes that patients and therapists consider central to quality. They also leave largely implicit the ongoing, practice-based work through which care is shaped in interaction. A broader understanding of quality—one that is sensitive to relational dynamics, meaning-making, and systemic conditions—may complement existing evaluation approaches and contribute to a more comprehensive view of mental healthcare practice.