The Cardinal Needs Schedule--a modified version of the MRC Needs for Care Assessment Schedule.

This paper describes a modified version of the MRC Needs for Care Schedule (the Cardinal Needs Schedule), for measuring needs for psychiatric and social care amongst patients with severe psychiatric disorders. The modified schedule has three new features: (i) it is quick and easy to use; (ii) it takes systematic account of the views of patients and their carers; (iii) it defines and identifies need in a way that is concise and easy to interpret. The paper describes why the three new features were considered necessary, and then gives an overview of the structure of the Cardinal Needs Schedule, together with a description of how the three new features were developed. During a study of social services care management the practicality of the modified schedule was investigated and further data were obtained on the reliability and validity of the standardized approach to measuring need, in domains not previously investigated. Because of its speed and simplicity, the Cardinal Needs Schedule offers a new choice to researchers who wish to use a standardized and practical assessment of need in evaluative studies of community care. Examples of the usage of the modified schedule are given in an Appendix.

Can we measure need in the homeless mentally ill? Using the MRC Needs for Care Assessment in hostels for the homeless.

Hostels for the homeless contain many who are disabled by chronic mental illness but have little access to rehabilitation services. One approach to solving this problem might be to measure the needs of hostel residents in a standardized way and use this information as a basis for planning interventions. This study attempted to use the MRC Needs for Care Assessment Schedule to measure the needs of 46 mentally ill residents of Oxford hostels. It aimed to determine if a standardized assessment could be used in these difficult settings and if the needs it identified could form a useful basis for planning future interventions. Although it was possible to use the schedule, and although the pattern of need identified appeared broadly to reflect conditions in the hostels, it was not felt that the information produced was of sufficient quality to assist in planning services. The authors postulate that underlying this deficiency is the failure of the schedule to take sufficient account of the views of staff and residents.

New chronic schizophrenic patients: a comparison of daypatients and inpatients.

A group of 24 "new chronic" schizophrenic inpatients was compared with a group of 19 daypatients matched for duration of current care; both had spent between 1 and 6 years in continuous inpatient or daypatient care. The groups were compared on a variety of clinical, demographic, and social variables to identify specific variables that might distinguish the new chronic inpatient group. Despite a few nonsignificant trends in the data, the groups were found not to differ significantly on any variables. Both groups had long psychiatric histories with many previous hospital admissions, presented many negative symptoms of schizophrenia at interview, were quite disabled in terms of self-care and speech skills, had a low incidence of behavioural disturbance and had few contacts outside of the hospital. The majority of both groups expressed a clear preference for community care. The results therefore highlight the urgent need for more comprehensive and detailed assessment of patients in relation to decisions about retention in or discharge from inpatient hospital care and also the need to identify objective predictors of the success of such decisions.