title: The needs of older people with mental health problems according to the user, the carer, and the staff.
abstract: BACKGROUND
  Individual assessment of needs has been recognised as the most appropriate way to allocate health and social care resources. These assessments, however, are often made by the staff or by a carer who acts as an advocate for the user themselves. Little is known about how these proxy measures compare to how individual patients perceive their own needs.
  
  
  OBJECTIVE
  The aim of this study was to measure and compare ratings of need for older people with mental health problems by the older person themselves, their carer, and an appropriate staff member.
  
  
  METHODS
  One-hundred and one older people were identified from various mental health services and 87 users, 57 carers, and 95 staff were interviewed using the Camberwell Assessment of Need for the Elderly (CANE) to identify met and unmet needs.
  
  
  RESULTS
  Users identified significantly fewer of their needs (5.5) than either staff (8.1) or carers (8.3) did, but this difference was accounted for by people with dementia reporting less needs. Users identified fewer psychological or social needs (e.g. daytime activities, company, or carer distress) than staff or carers did. The average Kappa indicating level of agreement between staff and user was 0.52, between user and carer was 0.53, and between carer and user was 0.58. This showed only a fair level of reliability between different ratings of need.
  
  
  CONCLUSIONS
  User perspectives should be given a high priority when assessing individual needs. Fears that assessment of need would be unduly time-consuming or would simply reflect individual demands should be allayed. A user-based assessment will assist healthcare providers to prioritise needs according to what the user themselves consider to be most important, beneficial, and acceptable to them. Reliance solely on assessment by staff or carers may not lead to the most equitable or appropriate use of services.
authors.affiliation: Department of Psychiatry and Behavioural Sciences, University College London, London, UK.
authors.forename: Geraldine A
authors.initials: GA
authors.lastname: Hancock
authors.forename: Tom
authors.initials: T
authors.lastname: Reynolds
authors.forename: Bob
authors.initials: B
authors.lastname: Woods
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
authors.forename: Martin
authors.initials: M
authors.lastname: Orrell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D005852:Geriatric Psychiatry; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D028642:Persons with Psychiatric Disorders / Q000523:psychology; D020380:Needs Assessment; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D006113:United Kingdom