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Assessing Population Need for Mental Health Care: A Review of Approaches and Predictors

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Mental Health Services Research

Abstract

This review aimed to clarify the concept of need, explore the different approaches used to assess need, and contribute to an improved understanding of predictor and intervening factors in assessing need for mental health services. Two population-based needs assessment approaches have been identified: modeling need for services and surveys of the general population. The most widely used model was that based on the Jarman-8 index of social deprivation. The population-based epidemiological surveys addressed perceived need by seeking direct, self-reported measures of individuals' perceptions of their needs for care. Although many studies have reported correlates of service use, few have attempted to identify correlates of perceived need. The fact that two-thirds to three-quarters of people were identified as meeting criteria for a mental health disorder, but did not report receiving treatment, highlighted a gap between epidemiology and service use. This gap could be explained by a number of intervening factors such as the discordance between diagnosis and disability, the determinants of and barriers to help-seeking behavior, the belief systems concerning appropriate treatments, and choice of health professionals. This review has thus identified the predictor variables which are important for a comprehensive analysis of need for mental health care. Suggestions and challenges have been put forward to address the identified gaps in assessing population need.

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references

  • Andrade, L. (2000). Surveys of morbidity and psychiatric comorbidity. Current Opinion in Psychiatry, 13, 201-207.

    Google Scholar 

  • Andrews, G. (2000). Meeting the unmet need with disease management, In G. Andrews &; S. Henderson, Unmet need in psychiatry: Problems, resources, responses (pp. 11-36). Cambridge: Cambridge University Press.

    Google Scholar 

  • Andrews, G., Hall, W., Teeson, M., &; Henderson, S. (1999). The Mental health of Australians. Canberra, Australia: Mental Health Branch, Commonwealth Department of Health and Aged Care.

    Google Scholar 

  • Andrews, G., Sanderson, K., &; Beard, J. (1998). Burden of disease: Methods of calculating disability from mental disorder. British Journal of Psychiatry, 173, 123-131.

    Google Scholar 

  • Andrews, G., Sanderson, K., Slade, T., &; Issakidis, C. (2000). Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment. Bulletin of the World Health Organisation, 78 (4), 446-454.

    Google Scholar 

  • Andrews, G., &; Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health, 25 (6), 494-497.

    Google Scholar 

  • Armenian, H. K., Pratt, L. A., Gallo, J., &; Eaton, W. W. (1998). Psychopathology as a predictor of disability: A population-based follow-up study in Baltimore, Maryland. American Journal of Epidemiology, 21, 273-279.

    Google Scholar 

  • Australian Bureau of Statistics. (1999). National Survey of Mental Health and Wellbeing of Adults–-User's Guide. Australia: Australian Bureau of Statistics.

  • Bebbington, P. (1992). Assessing the need for psychiatric treatment at the district level: The role of surveys. In G. Thornicroft, C. Brewin, &; J. Wing (Eds.), Measuring mental health needs (pp. 99-117). London: Royal College of Psychiatrists.

    Google Scholar 

  • Bebbington, P., Marsden, L., &; Brewin, C. (1997). The need for psychiatric treatment in the general population: The Camberwell Needs for Care survey. Psychological Medicine, 27, 821-834.

    Google Scholar 

  • Bijl, R. V., &; Ravelli, A. (2000). Psychiatric morbidity, service use and needs for care in the general population: Results of the Netherlands mental health survey and incidence study. American Journal of Public Health, 175, 327-330.

    Google Scholar 

  • Brewin, C. (1992). Measuring individual needs for care and services. In G. Thornicroft, C. Brewin, &; J. Wing (Eds.), Measuring mental health needs. London: Royal College of Psychiatrists.

    Google Scholar 

  • Bristow, K., &; Patten, S. (2002). Treatment-seeking rates and associated mediating factors among individuals with depression. Canadian Journal of Psychiatry, 47 (7), 660-665.

    Google Scholar 

  • Buckingham, B., &; Burgess, P. (unpublished report). Mental heath needs and expenditure in Australia. Australia: Commonwealth Department of Health and Aged Care.

  • Burgess, P. M., Joyce, C. M., Pattison, P. E., &; Finch, S. J. (1992). Social indicators and the prediction of psychiatric inpatient service utilization. Social Psychiatry and Psychiatric Epidemiology, 27 (2), 83-94.

    Google Scholar 

  • Car-Hill, R., &; Sheldon, T. (1992). Rationality and the use of formulae in the allocation of resources to health care. Journal of Public Health Medicine, 14 (2), 117-126.

    Google Scholar 

  • Ciarlo, J. A., &; Tweed, D. L. (1992). Implementing indirect needs assessment models for planning state mental health and substance abuse services. Evaluation Program Planning, 15, 195-210.

    Google Scholar 

  • Commonwealth Department of Health and Aged Care. (1999). Mental health information development: National information priorities and strategies under the second national mental health plan 1998-2003. Canberra, Australia: Commonwealth of Australia.

  • Cowley, S., Bergen, A., Young, K., &; Kavanagh, A. (2000). A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice. Journal of Advanced Nursing, 31 (1), 126-134.

    Google Scholar 

  • Cullen, M. (2001). Interrelations of social capital with health and mental health: Discussion paper. National Mental Health Strategy. Commonwealth of Australia, Canberra.

    Google Scholar 

  • Daly, A., Saunders, D., &; Roberts, L. (2001). 2000 Collaborative health and wellbeing survey: An overview. Health Department of Western Australia Report, Perth.

  • Finlay-Jones, R. A., &; Murphy, E. (1979). Severity of psychiatric disorder and the 30-item general health questionnaire. The British Journal of Psychiatry, 134, 609-616.

    Google Scholar 

  • Gemignani (2001). Minorities´ unmet mental health needs. Business and Health, 19 (9), 10-14.

    Google Scholar 

  • Gilbody, S., House, A., &; Sheldon, T. (2002). Outcome research in mental health. British Journal of Psychiatry, 181, 8-16.

    Google Scholar 

  • Goodchild, M. E., &; Duncan-Jones, P. (1985). Chronicity and the General Health Questionnaire. The British Journal of Psychiatry, 146, 55-61.

    Google Scholar 

  • Holloway, F. (2002). Unmet need in psychiatry: Problems, resources, responses. [G. Andrews, &; S. Henderson (Eds), Book review] British Journal of Psychiatry, 180, 91-92.

    Google Scholar 

  • Holman, C. D., Rouse, I. L., &; Hobbs, M. S. (1999). Population-based linkage of health records in Western Australia: Development of a health services research linked database. Australian and New Zealand Journal of Public Health, 23 (5), 453-459.

    Google Scholar 

  • Hornblow, A., Bushnell, J. A., Wells, J. E., Joyce, P. R., &; Oakley-Browne, M. A. (1990). Christchurch psychiatric epidemiology study: Use of mental health services. New Zealand Medical Journal, 103, 415-417.

    Google Scholar 

  • Hourani, L., &; Khlat, M. (1986). Determinants of perceived mental health status and help-seeking behavior: Preliminary testing of a conceptual model. Social Science and Medicine, 22 (10), 1081-1086.

    Google Scholar 

  • Hunt, C. (2000). The unmet need for treatment in panic disorder and social phobia, In G. Andrews &; S. Henderson (Eds), Unmet need in psychiatry: Problems, resources, responses (pp. 277-289). Cambridge: Cambridge University Press.

    Google Scholar 

  • Jarman, B. (1983). Identification of underprivileged areas. BMJ, 286, 1705-1709.

    Google Scholar 

  • Jarman, B. (1984). Underprivileged areas: Validation and distribution of scores. BMJ, 289, 1587-1592.

    Google Scholar 

  • Jarman, B., Hirsch, S. R. (1992). Statistical models to predict psychiatric morbidity. In G. Thornicroft, C. Brewin, &; J. Wing, (Eds.), Measuring mental health needs (pp. 62-80). London: Royal College of Psychiatrists.

    Google Scholar 

  • Jarman, B., Hirsch, S. R., &; White, P. (1992). Predicting psychiatric admission rates. BMJ, 304, 1146-1151.

    Google Scholar 

  • Jenkinson, C., Layte, R., Lawrence, K., Petersen, S., Paice, C., &; Stradling, J. (1997). A shorter form health survey: Can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health Medicine, 19 (2), 179-186.

    Google Scholar 

  • Jorm, A., Korten, A., Rodgers, B., Politt, P., Jacomb, P., Christensen, H., et al. (1997). Belief systems of the general public concerning the appropriate treatments for mental disorders. Social Psychiatry and Psychiatric Epidemiology, 32, 468-473.

    Google Scholar 

  • Katz, S. J., Kessler, R. C., Frank, R. G., Leaf, P., Lin, E., &; Edlund, M. (1997). The use of outpatient mental health services in the United States and Ontario: The impact of mental morbidity and perceived need for care. American Journal of Public Health, 87, 1136-1143.

    Google Scholar 

  • Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51 (1), 8-19.

    Google Scholar 

  • Lehtinen, V., Joukamaa, M., Jyrkinen, E., Lahtela, K., Raitasalo, R., Maatela J., et al. (1990). Need for mental health services of the adult population in Finland: Results from the Mini-Finland Health Survey. Acta Psychiatrica Scandinavica, 81, 426-431.

    Google Scholar 

  • Lightfoot, J. (1995). Identifying needs and setting priorities: Issues of theory, policy and practice. Health and Social Care in the Community, 3 (2), 105-114.

    Google Scholar 

  • McAlpine, D., &; Mechanic, D. (2000). Utilization of specialty mental health care among persons with severe mental illness: The roles of demographics, need, insurance and risk. Health Services Research, 35, 277-292

    Google Scholar 

  • McDowell, I., &; Newell, C. (1996). Measuring Health. A guide to rating scales and questionnaires. New York, NY: Oxford University Press.

    Google Scholar 

  • McKenzie, K. (2000, July). Social capital and mental health. Paper presented in workshop on Interrelations of Social Capital With Health and Mental Health, World Bank, Washington DC.

    Google Scholar 

  • Meadows, G., Burgess, P., Bobevski, I., Fossey, E., Harvey C., &; Liaw, S. T. (2002). Perceived need for mental health care: Influences of diagnosis, demography and disability. Psychological Medicine, 32 (2), 299-309.

    Google Scholar 

  • Meadows, G., Burgess, P., Fossey E., &; Harvey, C. (2000). Perceived need for mental health care, findings from the Australian National Survey of Mental Health and Wellbeing. Psychological Medicine, 30, 645-656.

    Google Scholar 

  • Meadows, G., Fossey, E., Harvey C., &; Burgess, P. (2000). The assessment of perceived need. In G. Andrews &; S. Henderson (Eds.), Unmet need in psychiatry: Problems, resources, responses (pp. 390-398). Cambridge: Cambridge University Press.

    Google Scholar 

  • Narrow, W., Rae, D., Robins, L., &; Regier, D. (2002). Revised prevalence estimates of mental disorders in the United States. Archives of General Psychiatry, 59, 115-123.

    Google Scholar 

  • Parslow, R., &; Jorm, A. (2000). Who uses mental health services in Australia? An analysis of data from the National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 34, 997-1008.

    Google Scholar 

  • Parslow, R., &; Jorm, A. (2001). Predictors of types of help provided to people using services for mental health problems: An analysis of the Australian National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 35 (2), 183-189.

    Google Scholar 

  • Pearce, N. (1996). Traditional epidemiology, modern epidemiology and public health. American Journal of Public Health, 86, 678-683.

    Google Scholar 

  • Phelan, M., Slade, M., Thornicroft, G., Dunn, G., Holloway, F., &; Wykes T. (1995). The Camberwell assessment of need: The validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry, 167, 589-595.

    Google Scholar 

  • Rabinowitz, J., Gross, R., &; Feldman, D. (1999). Correlates of a perceived need for mental health assistance and differences between those who do and do not seek help. Social Psychiatry and Psychiatric Epidemiology, 34, 141-146.

    Google Scholar 

  • Regier, D. A., Kaelber, C., Rae, D. S., Farmer, M., Knauper, B., Kessler R., et al. (1998). Limitations of diagnostic criteria and assessment instruments for mental disorders: Implications for research and policy. Archives of General Psychiatry, 55, 109-115.

    Google Scholar 

  • Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., &; Goodwin, F. K. (1993). Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50 (2), 85-94.

    Google Scholar 

  • Rock, D., Combrinck J., &; Groves, A. (2001). Issues associated with the implementation of routine outcome measures in public mental health services. Australasian Psychiatry, 9 (1), 43-46.

    Google Scholar 

  • Saunders D., &; Daly, A. (2001). 2000 Collaborative Health and Wellbeing Survey: Psychological distress in the Western Australian population. Health Department of Western Australia Report, Perth.

  • Shapiro, S., Skinner, E. A., Kramer, M., Steinwachs, D. M., &; Reiger, D. A. (1985). Measuring need for mental health services in a general population. Medical Care, 23, 1033-1043.

    Google Scholar 

  • Smith, P., Sheldon T., &; Martin, S. (1996). An index of need for psychiatric services based on inpatient utilization. British Journal of Psychiatry, 169, 308-316.

    Google Scholar 

  • Sprangers, M. A. G., de Regt, E. B., &; Andries, F. (2000). Which chronic conditions are associated with better or poorer quality of life? Journal of Clinical Epidemiology, 53, 895-907.

    Google Scholar 

  • Stanley, F., Sanson A., &; McMichael, T. (2001, February). New ways of causal pathways thinking for public health. Paper prepared for the meeting of the proposed National Research Partnership in Developmental Health and Well-being. Australian Institute of Family Studies, Melbourne.

  • Stevens, A., &; Raftery, J. (1992). The purchasers´ information requirements on mental health needs and contracting for mental health services. In G. Thornicroft, C. Brewin, &; J. Wing (Eds), Measuring mental health needs. London: Royal College of Psychiatrists.

    Google Scholar 

  • Stevens, A., &; Raftery, J. (1994). Introduction in health care needs assessment: The epidemiological needs assessment review, Vol. 1. England: Oxford Radcliffe Medical.

    Google Scholar 

  • Thornicroft, G. (1991). Social deprivation and rates of treated mental disorder: Developing statistical models to predict psychiatric service utilization. British Journal of Psychiatry, 158, 475-484.

    Google Scholar 

  • Uphoff, N. (2000). Understanding social capital: Learning from the analysis and experience of participation. In P. Dasgupta &; I. Serageldin (Eds.), Social capital: A multifaceted perspective. Washington, DC: The World Bank.

    Google Scholar 

  • Williams, R., &; Wright, J. (1998). Health needs assessment: Epidemiological issues in health needs assessment. BMJ, 316 (7141), 1379-1382.

    Google Scholar 

  • World Health Organization (WHO). (2000a). Cross-national comparisons of the prevalences and correlates of mental disorders. Bulletin of the World Health Organisation, 78 (4), 413-426.

    Google Scholar 

  • World Health Organization (WHO). (2000b). Psychiatric epidemiology: Selected recent advances and future directions. Bulletin of the World Health Organisation, 78 (4).

  • World Health Organization (WHO). (2001). International classification of functioning, disability and health. Geneva: Australian Institute of Health and Welfare.

  • Wright, J., Williams R., &; Wilkinson, J. (1998). Health needs assessment: Development and importance of health needs assessment. BMJ, 316 (7140), 1310-1313.

    Google Scholar 

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Aoun, S., Pennebaker, D. & Wood, C. Assessing Population Need for Mental Health Care: A Review of Approaches and Predictors. Ment Health Serv Res 6, 33–46 (2004). https://doi.org/10.1023/B:MHSR.0000011255.10887.59

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