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Across international contexts, people with serious mental illnesses (SMI) experience marked reductions in life expectancy at birth. The intersection of ethnicity and social deprivation on life expectancy in SMI is unclear. The aim of this study was to assess the impact of ethnicity and area-level deprivation on life expectancy at birth in SMI, defined as schizophrenia-spectrum disorders, bipolar disorders and depression, using data from London, UK.
Abridged life tables to calculate life expectancy at birth, in a cohort with clinician-ascribed ICD-10 schizophrenia-spectrum disorders, bipolar disorders or depression, managed in secondary mental healthcare. Life expectancy in the study population with SMI was compared with life expectancy in the general population and with those residing in the most deprived areas in England.
Irrespective of ethnicity, people with SMI experienced marked reductions in life expectancy at birth compared with the general population; from 14.5 years loss in men with schizophrenia-spectrum and bipolar disorders, to 13.2 years in women. Similar reductions were noted for people with depression. Across all diagnoses, life expectancy at birth in people with SMI was lower than the general population residing in the most deprived areas in England.
Irrespective of ethnicity, reductions in life expectancy at birth among people with SMI are worse than the general population residing in the most deprived areas in England. This trend in people with SMI is similar to groups who experience extreme social exclusion and marginalisation. Evidence-based interventions to tackle this mortality gap need to take this into account.
The first edition of the CAN was published in 1995 by the Section of Community Psychiatry (PRiSM) at what is now called the Institute of Psychiatry, Psychology and Neuroscience in London, England. The accompanying book was published in 1999 by Gaskell, the imprint of the Royal College of Psychiatrists.
The Camberwell Assessment of Need Short Appraisal (CANSAS), 2nd edition, is a short (single page) summary of the needs of a mental health service user.
CANSAS can be used in clinical settings because it is short enough to be used for review purposes on a routine basis. It can be used for teaching, e.g. as part of pre-qualification or post-qualification training of mental health workers to support their development of skills in assessing the health and social needs of service users. Finally, it can be used as an outcome measure in research studies. CANSAS is the CAN version that is most commonly used in research studies, especially when a number of assessment schedules are being used.
The CAN is now the most widely used needs assessment measure in mental health systems internationally. For example, in relation to psychosis, it is the most widely cited measure in first-episode psychosis studies, and a review of patient-reported outcomes in schizophrenia concluded that ‘the most commonly used measures are the Camberwell Assessment of Need and the Camberwell Assessment of Need Short Appraisal Schedule’ (p. 22). It is also used to assess needs in diverse mental health groups (e.g. psychosis, bipolar disorder, common mental disorders) with other clinical (e.g. neurology, HIV) and non-clinical (e.g. sex trafficking, asylum seekers, non-clinical voice hearers) populations, and to compare the needs of different populations, such as people with and without intellectual disabilities in mental health case management services.
The Camberwell Assessment of Need-Research version (CAN-R), 2nd edition, is intended for use as an outcome measure for research purposes.
A copy of the 2nd edition of CAN-R that is suitable for scanning is provided in Appendix 6, with CAN-R summary score sheets in Appendix 7. These can also be downloaded as PDF files from the CAN website (researchintorecovery.com/can).
The original psychometric evaluation of the CAN was published in 1995, and the paper reporting this evaluation is included as Appendix 8. In brief, the selection of items to be included in the CAN-R was guided by validity studies, including surveys of people living with severe mental health problems and of mental health professionals. The psychometric evaluation of CAN-R involved people with severe mental health problems attending an inner-city mental health service, and their mental health professional. The mean total number of needs identified by staff (n = 60) was 7.55 and by service users (n = 49) was 8.64. Inter-rater reliability of the total number of needs identified by staff were 0.99, and test–retest reliability was 0.78. The percentage complete agreement on individual items ranged from 81.6 to 100% (inter-rater) and 58.1 to 100% (test–retest).
All versions of CAN involving staff completion (i.e. CANSAS, CAN-R, CAN-C) can be used without any formal training by mental health professionals. Each version contains a page outlining how to rate responses and, in the CAN-R and CAN-C, every rating has anchor points for guidance. Reading through the CAN-R or CAN-C will give the staff member a good overview of the approach used, and a relatively good assessment can be expected from the first use. The main improvement in subsequent assessments is likely to be in the time taken for assessment, which will reduce as familiarity with the measure increases.
The Camberwell Assessment of Need Short Appraisal Schedule – Patient (CANSAS-P), 2nd edition, is a short (two-page) self-rated measure completed by the mental health service user.
CANSAS-P can be used in clinical settings because it is short enough to be used for review purposes on a routine basis, or for completion before a clinical meeting to identify the service user’s perspective on their unmet needs. It can be used for teaching, e.g. as part of pre-qualification or post-qualification training of mental health workers in supporting mental health service users to identify their health and social needs. Finally, it can be used as an outcome measure in research studies.