Perceived needs in chronic schizophrenia

Abstract

Recent approaches to needs assessment involve patients themselves in the process, but little is known about the effects of mental illness on their ability to judge their own needs accurately. The needs of 30 subjects with schizophrenia in rehabilitation units were assessed in 19 different domains, by obtaining the views both of the subjects and their keyworkers. For each, the number of domains in which the subjects underestimated their level of need compared with the level estimated by their keyworker was calculated, to give a ‘disparity score’. Disparity scores were positively correlated with severity of negative symptoms (r = 0.36; P = 0.048) but only nonsignificantly negatively correlated with insight (r = 0.31; P = 0.098). For the domains of alcohol misuse (P = 0.043) and quality of social life (P = 0.0005), subjects who underestimated their needs had poorer insight than those who did not do so. Subjects did not necessarily deny their need for help with psychosocial handicaps even if they denied having a mental illness or requiring medication. For the areas of alcohol misuse and social contact, however, additional objective means of assessment may be advisable in patients with poor insight into their illness. The effects of negative symptoms should also be taken into account when assessing needs collaboratively.