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Needs for care in psychiatric patients: a systematic review II. Needs for care on individual level

  • Antonio Lasalvia (a1), Benedetta Stefani (a1) and Mirella Ruggeri (a1)

Summary

Objective - The present paper represents the second part of a larger review on the studies assessing needs for care in mental health field. In the first part, studies assessing needs for services in the general population were reviewed. In this second part studies assessing needs on individual level were reviewed and the role played by the assessment of individual needs in planning mental health care was discussed. Methods - Studies published in 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 in the general population and in psychiatric patients were reviewed separately. The latter were reviewed on the basis of the diagnostic category (psychotic and non psychotic patients) and setting of care (outpatients and inpatients). Studies on particular categories, such as homeless, children and adolescents, elderly and patients with aggressive behaviour, have been also reviewed. Results - Psychotic patients show a wide range of both clinical and social needs. Patients followed by community-based mental health services show similar number of clinical and social needs, while inpatients (with the exception of acute patients) show more social needs. For both community-based mental health patients and inpatients, social needs are most frequently unmet and psychopharmacological treatments are used more frequently than psychotherapeutic or rehabilitative interventions. Non psychotic patients show lower number of needs than psychotic patients; these needs are both clinical and social, with a higher total number of clinical needs, but a higher number of unmet social needs. Conclusions - Studies on needs for care provide an interesting perspective on people suffering from mental illness. In the routine clinical practice needs assessment could be a valuable tool for providing specific, individualised and effective mental health care.

Scopo - Il presente articolo costituisce la seconda parte di un più ampio lavoro di revisione degli studi sui bisogni di cura in ambito psichiatrico. Nella prima parte sono stati analizzati i risultati degli studi sui bisogni di servizi nella popolazione generate. In questa seconda parte viene passata in rassegna la letteratura sui bisogni individuali e discusso il ruolo giocato dalla valutazione di tali bisogni nella pianificazione dell'assistenza psichiatrica. 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 internazionali) sono stati selezionati i lavori pubblicati sull'argomento da Gennaio 1980 a Giugno 1999. La revisione della letteratura è stata realizzata suddividendo gli studi condotti nella popolazione generale e quelli condotti su gruppi di pazienti psichiatrici. Questi ultimi studi, a loro volta, sono stati ulteriormente suddivisi in base alla categoria diagnostica (pazienti con disturbi psicotici e pazienti con disturbi non psicotici) e al setting (servizi territoriali e strutture di ricovero). Sono stati, inoltre, considerati gli studi condotti su particolari categorie di pazienti (senzatetto, bambini ed adolescenti, anziani e soggetti con comportamento violento). Risultati - I pazienti con disturbi di tipo psicotico presentano una vasta gamma di bisogni sia di tipo clinico che sociale. In quelli seguiti a livello territoriale, i bisogni clinici e sociali tendono ad equivalersi, mentre in quelli ricoverati (ad eccezione dei pazienti acuti) prevalgono i bisogni sociali. Sia a livello territoriale che di strutture di ricovero i bisogni di tipo sociale sono quelli in genere più di frequente insoddisfatti; le terapie psicofarmacologiche sono fornite con maggior frequenza rispetto agli interventi psicoterapeutici e riabilitativi. I pazienti non psicotici presentano un numero minore di bisogni rispetto ai pazienti psicotici; tali bisogni sono di tipo sia clinico che sociale, con una prevalenza dei primi, anche se i bisogni più frequentemente insoddisfatti sono quelli sociali. Conclusioni - Tali studi forniscono preziose informazioni sulle principali esigenze dei soggetti affetti da disturbi psichici attraverso una prospettiva nuova e spesso inesplorata. Nella pratica clinica l'identificazione dei bisogni di cura può costituire un ausilio indispensabile al fine di impostare strategie terapeutiche specifiche, individualizzate ed efficaci.

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Corresponding author

Indirizzo per la corrispondenza: Dott.ssa Mirella Ruggeri, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Ospedale Policlinico, 37134 Verona. Fax: +39-045-585.871 E-mail: mruggeri@borgoroma.univr.it

References

Hide All
Banerjee, S. (1998). Needs of special groups: the elderly. International Review of Psychiatry 10, 30133.
Bebbington, P.E., Brewin, C.R., Marsden, L. & Lesage, A. (1996). Measuring the need for psychiatric treatment in the general population: the community version of the MCR Needs for Care Assessment. Psychological Medicine 26, 229236.
Bebbington, P.E., Mardsen, L. & Brewin, C.R. (1997). The need for psychiatric treatment in the general population: the Camberwell Needs for Care survey. Psychological Medicine 27, 821834.
Black, S.B., Rabins, P.V., German, P., McGuire, M. & Roca, R. (1997). Need and unmet need for mental health care among elderly public housing residents. Gerontologist 6, 1997.
Bouras, N., Webb, Y., Clifford, P., Papadatos, Y. & Zouni, M. (1992). A needs survey among patients in Leros asylum. British Journal of Psychiatry 161, 7579.
Brewin, C.R., Wing, J.K., Mangen, S.P., Brugha, T.S. & MacCarthy, B. (1987). Principles and practice of measuring needs in the long-term mentally ill: the MRC Needs for Care Assessment. Psychological Medicine 17, 971981.
Brewin, C.R., Wing, J.K., Mangen, S.P., Brugha, T.S., MacCarthy, B. & Lesage, A. (1988). Needs for care among the long-term mentally ill: a report from the Camberwell High Contact Survey. Psychological Medicine 18, 457468.
Brugha, T.S., Wing, J.K., Brewin, C.R., MacCarthy, B., Mangen, S.P., Lesage, A. & Mumford, J. (1988). The problems of people in longterm psychiatric day care. Psychological Medicine 18, 443456.
Brugha, T.S., Wing, J.K. & Smith, B.L. (1989). Physical health of the long-term mentally ill in the community. Is there unmet need? British Journal of Psychiatry 155, 777781.
Clifford, P., Charman, A., Webb, Y., Craig, T. & Cowan, D. (1991). Planning for community care: The Community Placement Questionnaire. British Journal of Clinical Psychology 30, 193211.
Compton, S. & Brugha, T. (1988). Problems in monitoring needs forcare of long term psychiatric Patients: evaluating a service for casual attenders. Social Psychiatry and Psychiatric Epidemiology 23, 121125.
Comtois, G., Morin, C., Lesage, A., Lalonde, P., Likavcanova, E. & L'Ecuyer, G. (1998). Patients versus rehabilitation practitioners: a comparison of assessment of needs for care. Canadian Journal of Psychiatry 43, 159165.
Flisher, A.J., Kramer, R.A., Grosser, R.C., Alegria, M., Bird, H.R., Bourdon, K.H., Goodman, S.H., Greenwald, S., Horwitz, S.M., Moore, R.E.. Narrow, W.E. & Hoven, C.W. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine 27, 11451154.
Galletta, M., Lasalvia, A. & Ruggeri, M. (1999). I bisogni di cura dei pazienti psichiatrici in relazione alle loro caratteristiche demografiche, cliniche, sociali e di interazione con i servizi. Rivista Sperimcntale di Freniatria 4, 237249.
Garralda, E. (1998). Needs of special groups: children. International Review of Psychiatry 10, 134135.
Goldberg, D. & Hillier, V.F. (1979). A scaled version of the General Health Questionnaire. Psychological Medicine 9, 139145.
Hansson, L., Bjrkman, T. & Svensson, B. (1995). Inter-rater reliability of the Swedish version of the Camberwell Assessment of Needs instrument and results from a cross-sectional study. Acta Psychiatrica Scandinavica 92, 285293.
Herman, D.B., Stmening, E.L. & Barrow, S.M. (1993). Self-assessed need for mental health services among homeless adults. Hospital and Community Psychiatry 44, 11811183.
Hogg, L.I. & Marshall, M. (1992). Can we measure need in the homeless mentally ill? Using the MRC Needs for Care Assessment in hostels for the homeless. Psychological Medicine 22, 10271034.
Holloway, F. (1991a). Day care in an inner city. I. Characteristics of attenders. British Journal of Psychiatry 158, 805810.
Holloway, F. (1991b). Day care in an inner city. II. Quality of the services. British Journal of Psychiatry 158, 810816.
Kazarian, S.S., McCabe, S.B. & Joseph, L.W. (1997). Assessment of service needs of adult psychiatric inpatients: a systematic approach. Psychiatric Quarterly 68, 523.
Lasalvia, A., Stefani, B. & Ruggeri, M. (2000). I bisogni di cura nei pazienti psichiatrici: una revisione sistematicadella letteratura. I. Concetti generali e strumenti di valutazione. I bisogni di servizi. Epidemiotogia e Psichiatria Sociale 9, 190212.
Leese, M., Johnson, S., Slade, M., Parkman, S., Kelly, F., Phelan, M. & Thornicroft, G. (1998). User perspective on needs and satisfaction with mental health services. British Journal of Psychiatry 173, 409415.
Lesage, A.D., Mignolli, G., Faccincani, C. & Tansella, M. (1991a). Standardised assessment of the needs for care in a cohort of patients with schizophrenic psychoses. In Community-based Psychiatry: Long-term Patterns of Care in South-Verona (ed. Tansella, M.). Psychological Medicine Monograph Supplement 19, Cambridge University Press: Cambridge.
Lesage, A.D., Cope, S.J. & Pezeshgi, S. (1991b). Assessing the needs for care of non-psychotic patients. A trial with a new standardised procedure. Social Psychiatry and Psychiatric Epidemiology 26, 281286.
Marshall, M., Hogg, L.I., Gath, D.H. & Lockwood, A. (1995). The Cardinal Needs Schedule - a modified version of the MRC Needs for Care Assessment Schedule. Psychological Medicine 25, 605617.
Middelboe, T., Mackeprang, T., Thalsgaard, A. & Christiansen, P.B. (1998). A housing support programme for the mentally ill: need profile and satisfaction among users. Acta Psychiairica Scandinavica 98, 321327.
Murray, V., Walker, H.W., Mitchell, C. & Pelosi, A.J. (1996). Needs for care from demandled community psychiatric service: a study of patients with major mental illness. British Medical Journal 312, 15821586.
O'Leary, D. & Webb, M. (1996). The needs for care assessment n a longitudinal approach. Psychiatric Bulletin 20, 134136.
Phelan, M., Slade, M., Thornicroft, G., Dunn, G., Hollway, F., Wykes, T., Strathdee, G., Loftus, L., McCrone, P. & Hayward, P. (1995). The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry 167, 589595.
Phillips, J. (1997). Meeting the psychiatric needs of children in foster care. Social workers' view. Psychiatric Bulletin 21, 609611.
Pryce, I.G., Griffiths, R.D., Gentry, R.M., Hughes, I.C.T., Montague, L.R., Watkins, S.E., Champney-Smith, J. & McLackland, B.M. (1991). The nature and severity of disabilities in long-stay psychiatric in patients in South Glamorgan. British Journal of Psychiatry 158, 817821.
Pryce, I.G., Griffiths, R.D., Gentry, R.M., Hughes, I.C.T., Montague, L.R., Watkins, S.E., Champney-Smith, J. & McLackland, B.M. (1993). How important is the assessment of social skills in current long-stay inpatients? An evaluation of clinical response to needs for assessment, treatment, and care in a long-stay psychiatric in-patient population. British Journal of Psychiatry 162, 498502.
Ralston, G., Beesley, S. & Bogue, J. (1998). Users' needs and satisfaction with a community-based mental health service. Psychiatric Bulletin 22, 473476.
Rosenheck, R. & Lam, J.A. (1997). Homeless mentally ill clients' and providers'. Perceptions of service needs and clients' use of services. Psychiatric Services 48, 381386.
Ruggeri, M., Lasalvia, A., Nicolaou, S. & Tansella, M. (1999). La versione italiana della Camberwell Assessment of Need (CAN), un'intervista per l'identificazione dei bisogni di cura. Epidemiologia e Psichiatria Sociale 8, 135167.
Ruud, T., Martinsen, E.W. & Friis, S. (1998). Chronic patients in psychiatric institutions: psychopathology, level of functioning and need for care. Acta Psychiatrica Scandinavica 97, 5561.
Salokangas, R.K.R., Palo-oja, T., Ojanen, M. & Jalo, K. (1991a). Need for community care among psychotic outpatients. Acta Psychiatrica Scandinavica 84, 191196.
Salokangas, R.K.R., Palo-oja, T. & Ojanen, M. (1991b). The need for social support among out-patients suffering from functional psychosis. Psychological Medicine 21, 209217.
Slade, M., Phelan, M., Thornicroft, G. & Parkman, S. (1996). The Camberwell Assessment of Need (CAN): comparison of assessments by staff and patients of the needs of the severely mentally ill. Social Psychiatry and Psychiatric Epidemiology 31, 109113.
Slade, M., Phelan, M. & Thornicroft, G. (1998). A comparison of needs assessed by staff and by an epidemiologically representative sample of patients with psychosis. Psychological Medicine 28, 543550.
Stansfeld, S., Orrel, M., Mason, R., Nicholls, D. & D'Ath, P. (1998). A pilot study of needs assessment in acute psychiatric inpatients. Social Psychiatry and Psychiatric Epidemiology 33, 136139.
Stevens, A., Gooder, P. & Drey, N. (1998). Care needs of people with mental illness and aggression. Psychiatric Bulletin 22, 3641.
van Haaster, I., Lesage, A.D., Cyr, M. & Toupin, J. (1994). Problems and needs for care of patients suffering from severe mental illness. Social Psychiatry and Psychiatric Epidemiology 29, 141148.
Wiersma, D., Nienhuis, F.J., Giel, R., de Jong, A. & Slooff, C.J. (1996). Assessment of the need for care 15 years after onset of a Dutch cohort of patients with schizophrenia and an international comparison. Social Psychiatry and Psychiatric Epidemiology 31, 114121.
Wiersma, D., Nienhuis, F.J., Giel, R., de Jong, A. & Slooff, C.J. (1998). Stability and change in needs of patients with schizophrenic disorders: a 15 and 17-year follow-up from first onset of psychosis, and a comparison between «objective» and «subjective» as-sessments of needs for care. Social Psychiatry and Psychiatric Epidemiology 33, 4956.
Wykes, T., Creer, C. & Sturt, E. (1982). Needs and the deployment of services. In Long-term Community Care: Experience in a London Borough (ed. Wing, J.K.). Monograph Supplement 2, Psychological Medicine, Cambridge University Press: Cambridge.
Wykes, T., Sturt, E. & Creer, C. (1985). The assessment of patients' needs for community care. Social Psychiatry 20, 7685.
World Health Organization (1992). Schedules for Clinical Assessment in Neuropsychiatry (ed. Wing, J.K.). WHO: Geneva.

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