title: Mental health and social service needs for mental health service users in Japan: a cross-sectional survey of client- and staff-perceived needs.
abstract: BACKGROUND
  The appropriate utilization of community services by people with mental health difficulties is becoming increasingly important in Japan. The aim of the present study was to describe service needs, as perceived by people with mental health difficulties living in the community and their service providers. We analyzed the difference between two necessity ratings using paired data in order to determine implications related to needs assessment for mental health services.
  
  
  METHODS
  This cross-sectional study used two self-reported questionnaires, with one questionnaire administered to mental health service users living in the community and another questionnaire to staff members providing services to those users at community service facilities. The study was conducted in psychiatric social rehabilitation facilities for people with mental health difficulties in Japan. The paired client and staff responses rated needs for each kind of mental health and social service independently. The 19 services listed in the questionnaire included counseling and healthcare, housing, renting, daily living, and employment. Overall, 246 individuals with mental health difficulties were asked to participate in this study, and after excluding invalid responses, 188 client-staff response dyads (76.4% of recruited people, 83.6% of people who gave consent) were analyzed in this study. A Wilcoxon matched-pairs signed rank test was used to compare the perceived needs, and weighted and unweighted Kappa statistics were calculated to assess rating agreement within client-staff dyads.
  
  
  RESULTS
  Over 75% of participants in our study, who were people with mental health difficulties living in the community, regarded each type of mental health service as "somewhat necessary," or "absolutely necessary" to live in their community. Most clients and staff rated healthcare facilities with 24/7 crisis consultation services as necessary. Agreement between client and staff ratings of perceived needs for services was low (Kappa = .02 to .26). Services regarding housing, renting a place to live, and advocacy had the same tendency in that clients perceived a higher need when compared to staff perceptions (p < .01).
  
  
  CONCLUSIONS
  It is essential for the service providers to identify the services that each user needs, engage in dialogue, and involve clients in service planning and development.
authors.affiliation: Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033 Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: School of Nursing and Nutrition, Shukutoku University, 673 Nitona, Chuo-ku, Chiba, 260-8703 Japan.
authors.forename: Rieko
authors.initials: R
authors.lastname: Hashimoto-Koichi
authors.affiliation: Division of Nursing, Faculty of Healthcare, Tokyo Healthcare University, 4 Chome-1-17 Higashigotanda, Shinagawa, Tokyo 141-0022 Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Akiyama
authors.affiliation: School of Nursing, Seirei Christopher University, 3453 Mikataharacho, Kita Ward, Hamamatsu, Shizuoka 433-8558 Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Takamura
keywords: Community mental health services; Consumer participation; Dialogue; Health services needs and demand; Housing; Mental health difficulties; Needs assessment; Patient-centered care; Schizophrenia; Shared decision making