NEEDS FOR CARE FROM A DEMAND LED COMMUNITY-PSYCHIATRIC-SERVICE - A STUDY OF PATIENTS WITH MAJOR MENTAL-ILLNESS

Objective-To measure needs for care of patients aged 18-65 years with major; mental illness. Design-Identification of everyone in one area s een 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-Hamilt on, a socially deprived district of Scotland. Subjects-71 subjects wer e interviewed from the original sample of 263 patients. Main outcome m easures-''Cardinal problems'' in seven clinical and eight social areas of functioning; these are defined as problems requiring action. ''Nee ds''-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 soci al needs. Skills to deal with all but seven needs in the sample were a vailable at the time of investigation. Patients not being seen by the community mental health team were similar in severity and levels of ne ed to those who were on the community team's caseload. Care was unequi vocally and severely inadequate for four patients. Shortcomings in ser vice delivery usually arose from failure to monitor some patients at h ome. Problems were not due to shortage of acute psychiatric beds nor t he absence of an elaborate assertive community care team. Conclusions- Systematic assessment of needs with research instruments can give valu able insights into the successes and failures of community care of peo ple 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 le ss severe disorders.