Schizophrenic patients' normative needs for community-based psychiatric care: an evaluative study throughout the year following hospital release in the Dresden region.

Abstract

The present study is part of a public health research project that evaluates restructured psychiatric community care for chronic patients in Saxony after the German reunification. It focuses on the analysis of the individual (expert-based) normative needs for mental health care of chronic schizophrenic patients in the Dresden region. A cohort of ICD-10 chronic schizophrenic patients (n = 115) was examined at 1, 6 and 12 months after hospital release using the Needs for Care Assessment. Schizophrenics' normative needs for care in the clinical sector are dominated by positive and negative symptoms, psychopharmacological side effects and psychosocial distress. In the social realm, problems dealing with the management of household affairs, recreational activities, household chores, occupation and communication skills are the most frequent areas of need. In the Dresden region, considerable deficits apparently persist in the subsections "recreational activities" and "occupational and communication skills", which can be ascribed to the lack of appropriate institutions of care in the area. Schizophrenic patients' normative needs for care cannot be determined simply on the basis of a few, quickly identifiable markers. Individualized analysis is needed that incorporates variables pertaining to psychopathology, subjective coping, social competence, and the course of the disorder. The development of the needs for care over the period of 1 year can be predicted by trends in the social realm that are already visible within the first months. Community-based care offers available for schizophrenic patients in the studied region are by no means generally insufficient. Identified deficits in focal fields of social skills and rehabilitation must be minimized to meet international standards. This is of special importance because social impairments/disabilities predominate over the entire spectrum of schizophrenics' normative needs for psychiatric care.