Self-assessment of need for help in patients undergoing psychiatric treatment

[The Standardised Recording of Psychosocial Help Needs within Psychiatric Acute Treatment in a Socio-Educational Counselling Context]

People with mental illness often have complex social problems. Up to now, there has been no systematised/standardised recording of social assistance needs in acute psychiatric care. One reason for this is the lack of adequate instruments and the increasing workload. The review analyses established needs assessment instruments with regard to their suitability for addressing the question. It becomes clear that these instruments are insufficiently suitable for a structured assessment of the need for psychosocial support. This results in the need for the development of a short and standardised instrument for the assessment of psychosocial support needs, which can be used as part of multiprofessional diagnostics within psychiatric care.

Factors associated with needs of users with severe mental disorders

For persons suffering from severe mental disorders (SMD), better quantification of needs may facilitate services planning and evaluation, as well as patient recovery. This study aimed to assess associations of sociodemographic, socioeconomic, service utilization, life events, social support and clinical variables with the level of perceived needs of users with SMD globally and according to their factorial structure. A total of 351 adults with SMD from Montreal (Canada) were interviewed using the Montreal Assessment of Needs Questionnaire and seven other standardized instruments. Clinical records were also consulted. Eight variables were associated with levels of needs. Four factors were extracted from the factor analysis and labeled respectively: Helplessness, Social Integration, Functional Skills and Interpersonal Relationships. Models built from needs assessment factors are stronger than global needs and have a greater association with pertinent variables. Linear regression models based on factors show the importance of satisfaction with life domains and substance abuse in association with higher levels of perceived needs. The recognition of variables associated with each factor would optimize care planning and implementation.

Clinical and psychosocial factors associated with needs for care: an Arab experience with a sample of treated community-dwelling persons with schizophrenia

OBJECTIVES

To (1) highlight the profile of the needs for care among a sample of persons with schizophrenia, using the Camberwell Assessment of Needs (CAN-EU), in comparison with the international data; (2) assess the association of patients' needs with socio-demographics, clinical characteristics and objective quality of life (QOL); and (3) compare the perceptions of patients with those of the staff.

METHOD

Consecutive outpatients in stable condition were interviewed with the CAN-EU and measures of QOL and psychopathology.

RESULTS

There were 130 patients (68.5% men, mean age 36.8). The highest frequency of unmet needs was for money (29.2%). About a fifth of the subjects expressed unmet needs for six other items, including accommodation. The mean total needs was 8.67(7.1), the total met needs was 5.29 and total unmet needs was 3.38. The dimension with the highest frequency (40%) of unmet needs (functioning) is constituted by items that are related to family care at home. Staff identified significantly more needs than patients. Higher levels of needs were significantly associated with severity of psychopathology and negative affect, and not participating in outdoor activities. The mean number of needs was similar to reports from developing countries and higher than those from European countries. The met/unmet need ratio was similar to European data.

CONCLUSION

Despite free health services and family support, a number of our treated community-dwelling persons with schizophrenia had problems meeting basic and health-care needs. The findings call for a consideration of techniques for enhancing the capability of families to cope with the care of patients.

Needs assessment of individuals with serious mental illness: can it help in promoting recovery?

Needs of individuals with serious mental illness (SMI) must be understood in order to promote recovery. This study examined the needs of 206 individuals with SMI and compared their perceptions with those of their professional caregivers. Needs were reported in the areas of accommodations, psychotic symptoms, daytime activity, intimate relationships, and psychological distress. Caregivers reported more met needs, while individuals themselves reported more unmet needs. Results suggest that in order to promote recovery, services for persons with SMI should be developed in accordance with patients' most prominent needs, specifically in the social and personal areas of intimate and sexual relationships.

Measuring patient-reported outcomes in psychosis: conceptual and methodological review

BACKGROUND

There are calls to use patient-reported outcomes (PROs) routinely across mental health services. However, the use of PROs in patients with psychosis has been questioned.

AIMS

To examine the concepts and measures of four widely used PROs: treatment satisfaction, subjective quality of life, needs for care and the quality of the therapeutic relationship.

METHOD

We conducted a literature search of academic databases on concepts, characteristics and psychometric properties of the four PROs in patients with psychosis.

RESULTS

Although numerous concepts and measures have been published, evidence on the methodological quality of existing PROs is limited. Measures designed to assess distinct PROs showed a considerable conceptual, operational and empirical overlap, and some of them also included specific aspects. The impact of symptoms and cognitive deficits appears unlikely to be of clinical significance.

CONCLUSIONS

The popularity of PROs has not been matched with progress in their conceptualisation and measurement. Based on current evidence, some recommendations can be made. Distinct and short measures with clinical relevance and sufficient psychometric properties should be preferred. Future research should optimise the validity and measurement precision of PROs, while reducing assessment burden.

Subjective well-being, hope, and needs of individuals with serious mental illness

Hope, as a basic resource in human life, may affect individuals' perceptions of subjective well-being (SWB). Further, understanding individuals' needs is essential to improving their SWB. It is unclear how the impact of hope on SWB may be mediated by needs. The current study aimed to examine a mediation model for the relation between hope and SWB among individuals with serious mental illness (SMI). Face-to-face structured interviews were conducted with 172 individuals with SMI. Instruments included the Personal Wellbeing Index, the Hope Scale, and the Camberwell Assessment of Needs. Hope and needs were predictive of 40% of the variability in SWB, with hope being a stronger predictor. Having no needs was positively predictive of SWB, while total number of needs was negatively predictive of SWB. Path analyses revealed a strong direct effect of hope on SWB and a weaker, though still strong, indirect effect mediated through needs. The results underscore the importance of hope in improving SWB and, consequently, enhancing the recovery process of individuals with SMI. Therefore, mental health services should focus on hope-building.

Evaluating the CANSAS self-report (CANSAS-P) as a screening instrument for care needs in people with psychotic and affective disorders

We examined agreement between the CANSAS self-report version (CANSAS-P) and the Camberwell Assessment of Need (CAN) interview in 200 long-term patients with affective and psychotic disorders. Intra-class correlations were fair to good for unmet needs. Overall, more unmet needs were reported on the CANSAS-P than in the CAN interview. No differences were found for patients with psychotic versus affective disorders. We conclude from this that the CANSAS-P is a promising screening instrument to detect unmet needs in people with severe mental illnesses.