Problems and needs for care of patients suffering from severe mental illness

  • I. Van Haaster
  • A. D. Lesage
  • M. Cyr
  • J. Toupin
Original Paper


Recently, evaluative research has yielded a procedure, the Needs for Care Assessment Schedule (NFCAS), which articulates the problems and the corresponding interventions required by psychiatric patients in a systematic and reproducible manner that is of interest to both administrators and clinicians. Although the NFCAS decisions are ultimately subjective and there is no absolute standard, the procedure limits variation and offers a framework for comparison and further elaboration. A group of 98 patients who were receiving treatment at the Louis-Hippolyte Lafontaine Psychiatric Hospital in Montréal, Québec and who were suffering from severe mental disorders were assessed with the NFCAS procedure. Subjects were selected from four treatment settings representing different levels of problems and needs: long-term in- and outpatients and short-term in- and outpatients. Results of the NFCAS were examined, along with those of standardized questionnaires. The NFCAS allowed a comprehensive understanding of the clinical realities for problem and need assessment. There was an average of 3.9 clinical problems and 4.5 social problems per patient. Long-term patients and patients residing in the hospital had more problems. A total of 76% of the problems assessed were rated as receiving appropriate interventions, whereas 17% of the problems assessed were considered in need of an assessment or in need of treatment. A greater need for intervention was found for social problems than for clinical problems.


Public Health Mental Disorder Mental Illness Social Problem Clinical Problem 
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  1. 1.
    Brugha TS (1984) Needs for care: developing and evaluating services for the chronically mentally ill. Irish J Psychiatry 2: 10–13Google Scholar
  2. 2.
    Brewin CR, Wing JK, Mangen SP et al (1987) Principles and practice of measuring needs in the long-term mentally ill: the MRC Needs for Care Assessment. Psychol Med 18: 971–981Google Scholar
  3. 3.
    Toupin J, Lesage AD, Cyr M (1991) Évaluation des besoins en psychiatrie: aspects théoriques et confrontation de deux approaches. Can J Program Eval 6: 67–93Google Scholar
  4. 4.
    Wing JK, Cooper JE, Sartorius N (1974) The measurement and classification of psychiatric symptoms. An instruction manual for the PSE and CATEGO program. Cambridge University Press, CambridgeGoogle Scholar
  5. 5.
    Weissman MM, Sholomskas MA, John K (1981) The assessment of social adjustment. Arch Gen Psychiatry 38: 1250–1258Google Scholar
  6. 6.
    Wallace CJ (1986) Functional assessment in rehabilitation. Schizophr Bull 12: 604–630Google Scholar
  7. 7.
    Wykes T, Sturt E (1986) The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the SBS schedule. Br J Psychiatry 148: 1–11Google Scholar
  8. 8.
    Furman WM, Lund DA (1979) The assessment of patient needs: description of the level of care survey. J Psychiatr Treat Eval 1: 29–37Google Scholar
  9. 9.
    Wing JK (1990) Meeting the needs of people with psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 25: 2–8Google Scholar
  10. 10.
    Cormier HJ, Borus JF, Reed RB et al (1987) Combler les besoins de services de santé mentale des personnes atteintes de schizophrénie. Rev Can Psychiatrie 32: 454–458Google Scholar
  11. 11.
    Caton CLM, Muller C, Spitzer RL (1981) The community care schedule. New York State Psychiatric Institute, New YorkGoogle Scholar
  12. 12.
    Caton CLM, Goldstein J, Serrano O et al (1984) The impact of discharge planning on chronic schizophrenic patients. Hosp Community Psychiatry 36: 255–262Google Scholar
  13. 13.
    Solomon P, Gordon B, Davis JM (1984) Assessing the service needs of the discharged psychiatric patient. Soc Work Health Care 10: 61–69Google Scholar
  14. 14.
    Brugha TS, Wing JK, Brewin CR et al (1988) The problems of people in long-term psychiatric day care: an introduction to the Camberwell High Contact Survey. Psychol Med 18: 443–456Google Scholar
  15. 15.
    Lesage AD, Mignolli G, Faccincani C et al (1991) Standardized assessment of the needs for care in a cohort of patients with schizophrenic psychoses. Psychol Med [Monogr Suppl] 19: 27–34Google Scholar
  16. 16.
    Holloway F (1991) Day care in an inner city. I. Characteristics of attenders. Br J Psychiatry 158: 805–810Google Scholar
  17. 17.
    Holloway F (1991) Day care in an inner city. II. Quality of the services. Br J Psychiatry 158: 810–816Google Scholar
  18. 18.
    Pryce IG, Griffiths RD, Gentry RM et al (1991) The nature and severity of disabilities in long-stay psychiatric in-patients in South Glamorgan. Br J Psychiatry 158: 817–821Google Scholar
  19. 19.
    Brewin CR, Wing JK (1989) MRC Needs for Care Assessment Manual for Version Two (mimeo). MRC Social Psychiatry Unit, LondonGoogle Scholar
  20. 20.
    van Haaster I, Lesage AD, Cyr M et al (1994) Further reliability and validity studies of a procedure to assess the needs for care of the chronically mentally ill. Psychol Med (in press)Google Scholar
  21. 21.
    Schooler N, Hogarty GE, Weissman MM (1979) Social Adjustment Scale II (SAS-II). In: Hargreaves WA, Atkinson CC, Sorensen JE (eds) Resource materials for community mental health evaluators. US Government Printing Office, Washington, DCGoogle Scholar
  22. 22.
    Wallace CJ, Kochanowicz N, Wallace J (1985) Independent living skills survey. Mental Health Clinical Research Center for the Study of Schizophrenia, Los AngelesGoogle Scholar
  23. 23.
    McLellan AT, Luborsky L, Woody GE et al (1980) An improved diagnostic evaluation instrument for substance abuse patients, the Addiction Severity Index. J Nerv Ment Dis 168: 26–33Google Scholar
  24. 24.
    Conroy SW, Bradley VJ (1985) The Penhurst longitudinal study: a report of five years of research and analysis. Temple University Developmental Disabilities Center, Philadelphia, Human Services Research Institute, BostonGoogle Scholar
  25. 25.
    Cyr M, Toupin J, Lesage AD L'évaluation des problèmes psychosociaux chez des personnes ayant des problèmes psychiatriques graves. Rapport final soumis au CQRS. ISBN 2-92148600-8Google Scholar
  26. 26.
    Lesage AD, Morissette R (1993) Residential and palliative needs of persons with severe mental illness who are subject to long-term hospitalisation. Canada's Ment Health 41: 12–17Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • I. Van Haaster
    • 1
    • 2
  • A. D. Lesage
    • 3
  • M. Cyr
    • 4
  • J. Toupin
    • 5
  1. 1.Centre de Recherche Fernand-SeguinMontréalCanada
  2. 2.Departement de PsychologieUniversité de MontréalMontréalCanada
  3. 3.Centre de Recherche Fernand-SeguinHôpital Louis-H. LafontaineMontréalCanada
  4. 4.Département de PsychologieUniversité de MontréalMontréalCanada
  5. 5.Département de Psycho-éducationUniversité de SherbrookeSherbrookeCanada

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