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Needs for care in psychiatric patients: a systematic review. I. General concepts and assessment measures. Needs for services

Published online by Cambridge University Press:  11 October 2011

Antonio Lasalvia ,
Benedetta Stefani  and
Mirella Ruggeri
Antonio Lasalvia
Affiliation:
Unità di Valutazione dell'Esito, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Verona
Benedetta Stefani
Affiliation:
Unità di Valutazione dell'Esito, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Verona
Mirella Ruggeri*
Affiliation:
Unità di Valutazione dell'Esito, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dott.ssa Mirella Ruggeri, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Ospedale Policlinico, 37134 Verona. Fax: +39-045-585871 E-mail: mruggeri@borgoroma.univr.it
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Summary

Objective – In Italy, mental health care is in phase of reorganisation. In this frame the measurement of users' needs may be a useftil tool in planning individualised mental health service interventions and in their evaluation. Aims of the present study are (I) to highlight the basic concepts of 'needs for care' and give a brief description of the main needs assessment tools specifically developed for psychiatric patients; (II) to review studies assessing needs for mental health services in the general population; (III) to discuss the role played by the assessment of needs in planning mental health care. Methods – Studies published in the international literature from January 1980 to June 1999 were reviewed. The studies were located through a computerised search of the databases MEDLINE and PsycLit; in addition, the reference lists of the studies located through the computerised search and the content of main international psychiatric journals were manually scanned in order to avoid possible omissions. Studies assessing needs for services and studies assessing needs on individual level were separately reviewed. Both groups of studies, in turn, were divided in studies assessing needs for mental health care in the general population and in psychiatric patients. Results – Although most studies on needs for services used indirect methodologies and employed quite heterogeneous experimental design, they provide at large overlapping results. In the general population, about 60%- 70% of patients with anxiety, depression and other neurotic disorders and 30%-40% of psychotic patients do not receive any specialist mental health care, suggesting that the majority of subjects suffering from a psychiatric disorder do not receive the mental health care they need. Conclusions – Unmet needs for services show a higher frequency in patients with neurotic and depressive disorders, indicating a shortage in services delivery that should be taken into account both by psychiatrists and mental health planners. Moreover, the finding that a large number of patients suffering from psychotic disorders do not receive any kind of mental health care is of particular relevance for planning mental health services, since these subjects are usually the most problematic and difficult to treat.

Riassunto

Scopo – Nella fase di riorganizzazione dell'assistenza psichiatrica attualmente in corso in Italia, la valutazione dei bisogni degli utenti si pone come un valido ausilio tanto per la pianificazione dell'attività complessiva dei servizi, che per l'impostazione e la valutazione di strategic terapeutiche efficaci ed individualizzate. Il presente lavoro ha l'obiettivo di (I) puntualizzare il concetto di ‘bisogni di cura’ e passare in rassegna i principali strumenti di valutazione dei bisogni nei pazienti psichiatrici; (II) operare una revisione sistematica della letteratura sui bisogni di servizi di salute mentale nella popolazione generale; (III) discutere il ruolo giocato dalla valutazione dei bisogni nell'ambito della pianificazione dei servizi. Metodo – Mediante ricerca computerizzata (effettuata con i database MEDLINE e PsycLit) integrata da una ricerca manuale (realizzata consultando gli indici analitici delle principali riviste psichiatriche intemazionali), sono stati selezionati i lavori pubblicati sull'argomento da Gennaio 1980 a Giugno 1999. Sono stati considered separatamente gli studi che si occupano dei bisogni di servizi (relativi ad un generico bisogno di assistenza specialistica) da quelli che valutano i bisogni individuali (bisogni relativi a precise e specifiche tipologie di intervento e prestazioni fornite dai servizi di salute mentale). Entrambi i tipi di studi, a loro volta, sono stati ulteriormente differenziati in studi condotti nella popolazione generale e studi condotti su gruppi di pazienti psichiatrici. Risultati – Nonostante la maggioranza degli studi sui bisogni di servizi abbia utilizzato metodologie di tipo indiretto e sia stata realizzata con disegni sperimentali piuttosto eterogenei, i risultati appaiono in larga misura sovrapponibili. Nell'ambito della popolazione generale, il 60%-70% dei pazienti con disturbi dello spettro nevrotico ed il 30%-40% dei pazienti affetti da disturbi di tipo psicotico non è seguita dai servizi specialistici, il che fa supporre che la maggior parte dei soggetti con disturbi mentali non riceva tutta l'assistenza di cui ha bisogno. Conclusioni – I bisogni di servizi insoddisfatti si riscontrano con maggiore frequenza nei pazienti con disturbi dello spettro nevrotico e depressivo e questo fenomeno evidenzia una carenza che richiede senz'atro attenzione da parte sia dei clinici che degli amministratori. Inoltre, per la pianificazione dei servizi di salute mentale, assume particolare rilevanza il fatto che una quota cospicua dei pazienti affetti da disturbi di tipo psicotico sfugge all'attenzione dei servizi, in quanto essa rappresenta proprio la fascia di utenza più problematica e difficile da assistere.

Keywords

needs for careneeds for servicemental health service planningbisogni di curabisogni di servizipianificazione dei servizi di salute mentale.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 9 , Issue 3 , September 2000 , pp. 190 - 213
Copyright
Copyright © Cambridge University Press 2000

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