The Nordic Study on schizophrenic patients living in the community. Subjective needs and perceived help.

In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% ('telephone') to 84.0% ('psychotic symptoms'). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% ('telephone') and 80.6% ('food'). The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs. In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received. In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs. It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.

[Description of a group of psychiatric patients difficult to place]. / Beskrivelse af en gruppe svaert integrerbare psykiatriske patienter.

INTRODUCTION: There are long-term patients in psychiatric hospitals, who are often referred to as new long-stay patients: the heavy users consumers of psychiatric services and difficult-to-place patients. MATERIAL AND METHOD: Social characteristics, diagnosis, need for care, function, and admission patterns were compared in a group of heavy user patients (N = 39) and a group of difficult-to-place patients (N = 14). RESULTS AND DISCUSSION: The difficult-to-place patients were more often men, more often had a diagnosis of schizophrenia, had a lower socio-economic status, and lower GAF scores. The difficult-to-place patients rated the same amount of need for care as did the heavy users, but were assessed by the staff to have a greater need for care. The results support the view that the difficult-to-place patients comprise a distinct group. Services for the difficult-to-place patients must combine highly differentiated care with few demands and greater tolerance with respect to problem behaviour.

Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study.

OBJECTIVE: The present study is part of a Nordic multicentre study investigating the life and care situation of community samples of schizophrenic patients. The specific aim of the present part of the study was to examine the agreement between patients and their key worker concerning the presence of met and unmet needs in a number of life domains, and help or support given in these domains. METHOD: The comparisons were based on 300 matched pairs of assessments of need using the Camberwell Assessment of Need interview. RESULTS: The results showed that key workers identified slightly more needs, 6.17 vs. 5.76, a significant difference. There was a moderate or better agreement on the presence of a need in 17 of 22 life domains investigated, but in only 11 life domains concerning the presence of an unmet need. Disagreement concerning whether the patient was given the right kind of help or support was even more substantial. CONCLUSION: It is concluded that key workers and patients disagree particularly concerning unmet needs and that this is potentially related to a number of factors associated with the key worker and patient. It is also concluded that further research is needed to increase the knowledge concerning the sources of this disagreement if need assessment is to become a valid basis for service planning and individual treatment planning.

[The staff's knowledge of patients' social function and needs--in connection with discharge planning]. / Kontaktpersoners viden om psykiatriske patienters sociale funktion og behov--i forbindelse med udarbejdelse af udskrivningsplaner.

The aim of the study was to assess the staff's knowledge about the social functioning and needs of the patients. A cross-sectional study interviewing 48 staff members using the Camberwell Assessment of Need--CAN was carried out. In nine of CAN's 26 areas more than 5% of the staff did not know if the patient had a problem. Among the patients with a problem more than 5% of the staff could not assess the need for care in four areas. The staff generally had a good knowledge concerning the patients' need for care. CAN seem to be a relevant instrument for the purpose of discharge planning.