title: Needs for care from a demand led community psychiatric service: a study of patients with major mental illness.
abstract: OBJECTIVE--To measure needs for care of patients aged 18-65 years with major mental illness.
  
  
  METHODS
  Identification of everyone in one area seen by a health professional within the previous five years because of a psychotic disorder. Interview of a one in three sample of patients and their main carers with the cardinal needs schedule. SETTING--Hamilton, a socially deprived district of Scotland. SUBJECTS--71 subjects were interviewed from the original sample of 263 patients. MAIN OUTCOME MEASURES--"Cardinal problems" in seven clinical and eight social areas of functioning; these are defined as problems requiring action. "Needs"-cardinal problems for which suitable interventions exist but have not been tried recently. RESULTS--High levels of morbidity were found. 30 interviewed patients (42%; 95% confidence interval 31% to 54%) had one or more clinical needs. 35 (49%; 38% to 61%) had one or more social needs. Skills to deal with all but seven needs in the sample were available at the time of investigation. Patients not being seen by the community mental health team were similar in severity and levels of need to those who were on the community team's caseload. Care was unequivocally and severely inadequate for four patients. Shortcomings in service delivery usually arose from failure to monitor some patients at home. Problems were not due to shortage of acute psychiatric beds nor the absence of an elaborate assertive community care team. CONCLUSIONS--Systematic assessment of needs with research instruments can give valuable insights into the successes and failures of community care of people with major mental illness. Most needs could be dealt with in these patients but in our area (and probably most other parts of the United Kingdom) this would entail diversion of resources from people with less severe disorders.
authors.affiliation: Lanarkshire Healthcare NHS Trust, Hairmyres Hospital, East Kilbride.
authors.forename: V
authors.initials: V
authors.lastname: Murray
authors.forename: H W
authors.initials: HW
authors.lastname: Walker
authors.forename: C
authors.initials: C
authors.lastname: Mitchell
authors.forename: A J
authors.initials: AJ
authors.lastname: Pelosi
mesh_terms: D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000600:supply & distribution*; D003657:Decision Making; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011618:Psychotic Disorders / Q000628:therapy*; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors