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

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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.

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Acknowledgments

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

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Authors and Affiliations

  1. Dept. of Psychiatry, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

    Durk Wiersma, Rob van den Brink & Kerstin Wolters

  2. Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK

    Rosemarie McCabe, Donna J. Wright & Stefan Priebe

  3. Central Institute for Mental Health, Mannheim, Germany

    Jens Bullenkamp & Hans Salize

  4. University of Lund, Lund, Sweden

    Lars Hansson & Tommy Björkman

  5. Psychiatric University Hospital, Liverpool, UK

    Christoph Lauber

  6. Dept. of Social Psychiatry, University of Zürich, Zürich, Switzerland

    Wulf Rössler

  7. Dept. of Psychiatry, University of Granada, Granada, Spain

    Rafael Martinez-Leal & Francisco Torres-Gonzales

Authors
  1. Durk Wiersma
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  2. Rob van den Brink
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  3. Kerstin Wolters
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  4. Rosemarie McCabe
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  5. Jens Bullenkamp
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  6. Lars Hansson
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  7. Christoph Lauber
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  8. Rafael Martinez-Leal
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  9. Wulf Rössler
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  10. Hans Salize
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  11. Tommy Björkman
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  12. Francisco Torres-Gonzales
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  13. Donna J. Wright
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  14. Stefan Priebe
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Corresponding author

Correspondence to Durk Wiersma.

Appendix

Appendix

The Mediating Community Care Group includes the following: Granada: Marta Ribes Leyva, Maria F Soriano Peña, Beatriz Arroyo de Domingo. Groningen: Kerstin Wolters, Aukelien Mulder, Jappie Tiersma. London: Rakhee Haque. Lund: Tommy Björkman. Mannheim: Marita Reichenbacher, Anette Axt. Zurich: Patric Meyer, Minka Burgi. We are indebted to the clinicians and patients who took part in the Mediating Community Care study, to Dr Michael Dewey for statistical advice, and to Dr Patrick Healey and Greg Mills for software development and technical support.

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Wiersma, D., van den Brink, R., Wolters, K. et al. Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?. Soc Psychiat Epidemiol 44, 317–324 (2009). https://doi.org/10.1007/s00127-008-0432-z

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  • DOI: https://doi.org/10.1007/s00127-008-0432-z

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