Advertisement

Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?

  • Durk WiersmaEmail author
  • Rob van den Brink
  • Kerstin Wolters
  • Rosemarie McCabe
  • Jens Bullenkamp
  • Lars Hansson
  • Christoph Lauber
  • Rafael Martinez-Leal
  • Wulf Rössler
  • Hans Salize
  • Tommy Björkman
  • Francisco Torres-Gonzales
  • Donna J. Wright
  • Stefan Priebe
ORIGINAL PAPER

Abstract

Background

Mental health interventions should demonstrate an effect on patients’ functioning as well as his/her needs, in particular on unmet needs whose assessment depends on the perspective of either the patient or the clinician. However, individual met and unmet needs appear to change over time, qualitatively and quantitatively, raising questions about their sensitivity to change and about the association between level of needs and treatment.

Methods

Data on baseline and follow-up need assessment in community mental health services in four European countries in the context of a cluster randomised trial on a novel mental health service intervention were used, which involved 102 clinicians with key worker roles and 320 patients with schizophrenia or related psychotic disorders. Need assessment was performed with the Camberwell assessment of needs short appraisal schedule (CANSAS) among patients as well as clinicians. Focus is the sensitivity to change in unmet needs over time as well as the concordance between patient and clinician ratings and their relationship with treatment condition.

Results

At follow-up 294 patients (92%) had a full need assessment, while clinician rated needs were available for 302 patients (94%). Generally, the total number of met needs remained quite stable, but unmet needs decreased significantly over time, according to patients as well as to clinicians. Sensitivity to change of unmet needs is quite high: about two third of all unmet needs made a transition to no or met need, and more than half of all unmet needs at follow-up were new. Agreement between patient and clinician on unmet needs at baseline as well as follow-up was rather low, without any indication of a specific treatment effect.

Conclusions

Individual unmet needs appear to be quite sensitive to change over time but as yet less suitable as outcome criterion of treatment or specific interventions.

Keywords

need for care schizophrenia routine outcome assessment community mental health care 

Notes

Acknowledgments

Funding/Support: The study was funded by the Research Directorate of the European Commission within the Framework Programme 5 (QLG5-CT-2002-01938).

References

  1. 1.
    Arvidsson H (2008) The development of needs in a group of severely mentally ill: a 10-year follow-up study after the 1995 Swedish mental health care reform. Soc Psychiatry Psychiatr Epidemiol DOI:  10.1007/s00127-008-0356-7
  2. 2.
    Brewin CR, Wing JK, Mangen SP, Brugha TS, MacCarthy B (1987) Principles and practice of measuring needs in the long-term mentally ill: the MRC needs for care assessment. Psychol Med 17:971–981PubMedGoogle Scholar
  3. 3.
    Cleary M, Freeman A, Hunt GE, Walter G (2006) Patient and carer perceptions of need and associations with care-giving burden in an integrated adult mental health service. Soc Psychiatry Psychiatr Epidemiol 41:208–214PubMedCrossRefGoogle Scholar
  4. 4.
    Drukker M, Bak M, Driessen G, Van OJ, Delespaul PA (2007) Can the “Camberwell assessment of need” predict changes in care consumption? Tijdschr Psychiatr 49:305–314PubMedGoogle Scholar
  5. 5.
    Drukker M, van DK, Bak M, Mengelers R, Van OJ, Delespaul P (2008) The use of the Camberwell assessment of need in treatment: what unmet needs can be met? Soc Psychiatry Psychiatr Epidemiol 43:410–417PubMedCrossRefGoogle Scholar
  6. 6.
    Fakhoury WK, Priebe S (2002) The process of deinstitutionalization: an international overview. Curr Opin Psychiatry 15:187–192CrossRefGoogle Scholar
  7. 7.
    Hansson L, Bjorkman T, Svensson B (1995) The assessment of needs in psychiatric patients. Interrater reliability of the Swedish version of the Camberwell assessment of needs instrument and results from a cross-sectional study. Acta Psychiatr Scand 92:285–293PubMedCrossRefGoogle Scholar
  8. 8.
    Hansson L, Vinding HR, Mackeprang T, Sourander A, Werdelin G, Bengtsson-Tops A, Bjarnason O, Dybbro J, Nilsson L, Sandlund M, Sorgaard K, Middelboe T (2001) Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study. Acta Psychiatr Scand 103:45–51PubMedCrossRefGoogle Scholar
  9. 9.
    Joska J, Flisher AJ (2005) The assessment of need for mental health services. Soc Psychiatry Psychiatr Epidemiol 40:529– 539PubMedCrossRefGoogle Scholar
  10. 10.
    Kallert TW, Leisse M (2001) Schizophrenic patients’ normative needs for community-based psychiatric care: an evaluative study throughout the year following hospital release in the Dresden region. Soc Psychiatry Psychiatr Epidemiol 36:1–12PubMedCrossRefGoogle Scholar
  11. 11.
    Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276PubMedGoogle Scholar
  12. 12.
    Kovess-Masféty V, Wiersma D, Xavier M, Caldas de Almeida JM, Carta MG, Dubuis J, Lacalmontie E, Pellet J, Roelandt JL, Torres-Gonzalez F, Moreno Kustner B, Walsh D (2006) Needs for care among patients with schizophrenia in six European countries: a one-year follow-up study. Clin Pract Epidemol Ment Health 2:22PubMedCrossRefGoogle Scholar
  13. 13.
    Lasalvia A, Ruggeri M, Mazzi MA, Dall’Agnola RB (2000) The perception of needs for care in staff and patients in community-based mental health services. The South-Verona outcome project 3. Acta Psychiatr Scand 102:366–375PubMedCrossRefGoogle Scholar
  14. 14.
    Lockwood A, Marshall M (1999) Can a standardized needs assessment be used to improve the care of people with severe mental disorders? A pilot study of ‘needs feedback’. J Adv Nurs 30:1408–1415PubMedCrossRefGoogle Scholar
  15. 15.
    MacPherson R, Gregory N, Slade M, Foy C (2007) Factors associated with changing patient needs in an assertive outreach team. Int J Soc Psychiatry 53:389–396PubMedCrossRefGoogle Scholar
  16. 16.
    Marshall M, Hogg LI, Gath DH, Lockwood A (1995) The cardinal needs schedule–a modified version of the MRC needs for care assessment schedule. Psychol Med 25:605–617PubMedGoogle Scholar
  17. 17.
    McCrone P, Leese M, Thornicroft G, Schene AH, Knudsen HC, Vazquez-Barquero JL, Lasalvia A, Padfield S, White IR, Griffiths G (2000) Reliability of the Camberwell assessment of need–European version. EPSILON study 6. European psychiatric services: inputs linked to outcome domains and needs. Br J Psychiatry Suppl 177:s34–s40CrossRefGoogle Scholar
  18. 18.
    McGuffin P, Farmer A, Harvey I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Arch Gen Psychiatry 48:764–770PubMedGoogle Scholar
  19. 19.
    Meijer CJ, Koeter MWJ, Schene AH (2005) Temporal stability of needs for care and the relation with quality of life: a longitudinal study among patients with schizophrenia. In: Meijer CJ (ed) Quality of life and needs for care of patients with schizophrenia (thesis). University of Amsterdam, Amsterdam, pp 60–72Google Scholar
  20. 20.
    Nguyen TD, Attkisson CC, Stegner BL (1983) Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire. Eval Program Plann 6:299–313PubMedCrossRefGoogle Scholar
  21. 21.
    O’Leary D, Webb M (1996) The need for care assessment—a longitudinal approach. Psychiatr Bull 20:134–136CrossRefGoogle Scholar
  22. 22.
    Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P, Hayward P (1995) The Camberwell assessment of need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 167:589–595PubMedCrossRefGoogle Scholar
  23. 23.
    Priebe S, Fakhoury WK, Hoffmann K, Powell RA (2005) Morale and job perception of community mental health professionals in Berlin and London. Soc Psychiatry Psychiatr Epidemiol 40:223–232PubMedCrossRefGoogle Scholar
  24. 24.
    Priebe S, Huxley P, Burns T (1999) Who needs needs? Eur Psychiatry 14:186–188PubMedCrossRefGoogle Scholar
  25. 25.
    Priebe S, Huxley P, Knight S, Evans S (1999) Application and results of the Manchester short assessment of quality of life (MANSA). Int J Soc Psychiatry 45:7–12PubMedCrossRefGoogle Scholar
  26. 26.
    Priebe S, Mccabe R, Bullenkamp J, Hansson L, Lauber C, Martinez-Leal R, Rössler W, Salize HJ, Svensson B, Torres-Gonzales F, Brink van den RHS, Wiersma D, Wright DJ (2007) Structured patient-clinician communication and one-year outcome in community mental health care: a cluster randomised controlled trial. Br J Psychiatry (in press)Google Scholar
  27. 27.
    Ruggeri M, Leese M, Slade M, Bonizzato P, Fontecedro L, Tansella M (2004) Demographic, clinical, social and service variables associated with higher needs for care in community psychiatric service patients. The South Verona outcome project 8. Soc Psychiatry Psychiatr Epidemiol 39:60–68PubMedCrossRefGoogle Scholar
  28. 28.
    Salize HJ, Kustner BM, Torres-Gonzalez F, Reinhard I, Estevez JF, Rossler W (1999) Needs for care and effectiveness of mental health care provision for schizophrenic patients in two European regions: a comparison between Granada (Spain) and Mannheim (Germany). Acta Psychiatr Scand 100:328–334PubMedGoogle Scholar
  29. 29.
    Slade M, Beck A, Bindman J, Thornicroft G, Wright S (1999) Routine clinical outcome measures for patients with severe mental illness: CANSAS and HoNOS. Br J Psychiatry 174:404–408PubMedCrossRefGoogle Scholar
  30. 30.
    Slade M, Leese M, Taylor R, Thornicroft G (1999) The association between needs and quality of life in an epidemiologically representative sample of people with psychosis. Acta Psychiatr Scand 100:149–157PubMedCrossRefGoogle Scholar
  31. 31.
    Slade M, Phelan M, Thornicroft G (1998) A comparison of needs assessed by staff and by an epidemiologically representative sample of patients with psychosis. Psychol Med 28:543–550PubMedCrossRefGoogle Scholar
  32. 32.
    Slade M, Phelan M, Thornicroft G, Parkman S (1996) The Camberwell assessment of need (CAN): comparison of assessments by staff and patients of the needs of the severely mentally ill. Soc Psychiatry Psychiatr Epidemiol 31:109–113PubMedCrossRefGoogle Scholar
  33. 33.
    Wennström E, Wiesel FA (2006) The Camberwell assessment of need as an outcome measure in routine mental health care. Soc Psychiatry Psychiatr Epidemiol 41:728–733PubMedCrossRefGoogle Scholar
  34. 34.
    Wiersma D (2006) Needs of people with severe mental illness. Acta Psychiatr Scand Suppl 113:115–119CrossRefGoogle Scholar
  35. 35.
    Wiersma D, Giel R, Jong de A, Nienhuis FJ, Slooff CJ (1996) Assessment of the need for care 15 years after onset of a Dutch cohort of patients with schizophrenia, and an international comparison. Soc Psychiatry Psychiatr Epidemiol 31:114–121PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2008

Authors and Affiliations

  • Durk Wiersma
    • 1
    Email author
  • Rob van den Brink
    • 1
  • Kerstin Wolters
    • 1
  • Rosemarie McCabe
    • 2
  • Jens Bullenkamp
    • 3
  • Lars Hansson
    • 4
  • Christoph Lauber
    • 5
  • Rafael Martinez-Leal
    • 7
  • Wulf Rössler
    • 6
  • Hans Salize
    • 3
  • Tommy Björkman
    • 4
  • Francisco Torres-Gonzales
    • 7
  • Donna J. Wright
    • 2
  • Stefan Priebe
    • 2
  1. 1.Dept. of PsychiatryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  2. 2.Unit for Social and Community PsychiatryQueen Mary University of LondonLondonUK
  3. 3.Central Institute for Mental HealthMannheimGermany
  4. 4.University of LundLundSweden
  5. 5.Psychiatric University HospitalLiverpoolUK
  6. 6.Dept. of Social PsychiatryUniversity of ZürichZürichSwitzerland
  7. 7.Dept. of PsychiatryUniversity of GranadaGranadaSpain

Personalised recommendations