The gradual shift towards non-institutional treatment for severe and chronic psychiatric illnesses has been accompanied by a recognition of potentially harmful effects (‘burden’) upon the patient's caregivers. This paper aims to provide a framework for the development of further research into the burden of ‘community care’ by offering a clear definition of the burden concept, an exposition of the criteria for evaluating rating scales to measure the concept, a review of major rating scales of burden, and some suggestions for improvements in methodology which are urgently required.

This study examines the problems of client under-attendance at a psychiatric day centre. Demographic, psychiatric, psychometric and Semantic Differential measures were used. Several of these measures were significantly associated with under-attendance. Various methods are suggested for the identification of and reduction of the level of under-attendance.

An outline is provided of an experimental study of the classification of mental ill-health presented to general practitioners (GPs). Videotaped real-life consultations were assessed by 27 GPs for the purpose. A high degree of inter-observer variation was recorded. Some of the implications of the findings are discussed.

The 30-item General Health Questionnaire (GHQ) and the Clinical Interview Schedule (CIS) were administered to 120 consecutive attendere at a general practice in Northern Italy run by a doctor who had a formal psychiatric training. The Italian versions of both the GHQ and the CIS were found to be feasible instruments for general practice studies in Italy. GHQ misclassification rates, sensitivity and specificity values are presented for different cut-off scores, a total score of 5 or more being the best discriminator between ‘cases’ and ‘non-cases’. The prevalence of confirmed cases in this sample was 47·5%, a rate higher than those reported so far in developed and developing countries.