Needs of people with severe mental illness

Abstract

This study reviews conceptual and methodological issues of needs for care among people with severe mental illness (SMI) and presents data on their prevalence, correlates and consequences for mental health care. Focus is on the definition of the concept of need as what people can benefit from and its measurement by means of two instruments, the Needs for Care Assessment (NCA) and the Camberwell Assessment of Needs (CAN). The prevalence of needs among patients with SMI varies between 4 and 10, which appears to be rather unrelated to gender, age or education, but not to severity of symptoms, diagnosis or treatment setting. Important is the perspective of the beholder: patient and professional differ significantly from each other in the assessment of number of needs and their adequate fulfillment. One of two to four needs are unmet, in particular in the area of psychological distress, daily activities, social contacts and psychotic symptoms. Prevalence of unmet needs seems to be related to the system of mental health care and to socioeconomic circumstances as well: the less integrated and continuous care and the poorer the life situation, the more unmet needs. Unmet needs are a strong predictor of less favourable health perceptions and a lower quality of life. Needs are to a certain extent changeable, and thus amenable by treatment or mental health interventions. The prevalence of (un)met needs should be an outcome criterion for the evaluation of mental health service systems and for cross-cultural comparison.