No abstract

The Psychiatric care reform in Sweden 1995 points out the importance of considering the patients' own experienced needs. Earlier research has shown that staff and patients differ in their assessment of needs, and the main aim of this study was to increase the understanding of these differences. The sample consisted of people in the city of Jönköping, Sweden, with a mental illness that cause a disability, influencing daily life. Four hundred and eighty-five patients were interviewed, half of them with a diagnosis of schizophrenia. Staff assessed the patients' needs by using the Camberwell Assessment of Need. Of the 485 patients 372 also assessed their own needs with the same instrument. The main finding of this study is that staff and patient ratings are not interchangeable. Staff rated more needs, both met and unmet, in nearly all areas. The results differ from those of earlier British studies. These differences may be due to methodologic and cultural circumstances. Decisions about interventions must be based on negotiations between staff and patient and should include relatives and friends.

The target group had made some progress. Due to methodological difficulties, it was not possible to ascribe these results to the reform, but the often negative picture of the reform deserves to be more nuanced.

This study investigated the reliability of the Global Assessment of Functioning Scale (GAF) when used by psychiatric staff from acute psychiatric wards. A special focus was attributed to factors predicting the reliability of the GAF.101 raters from six acute psychiatric wards assessed six GAF-vignettes. Intraclasscorrelation (ICC) with a model of absolute agreement was used as the overall reliability measure.An overall ICC of 0.79 was obtained. There were no significant differences found between the different occupational groups or psychiatric wards according to reliability. None of the predictive factors in the regression model yielded a significant contribution to reliability.The present study supports prior results of a reliability coefficient to be found mainly in the good to excellent range. There is supporting evidence that GAF ratings performed by trained psychiatric ward staff comprise a satisfactory reliability. The present study adds to prior research showing no consistent results between studies according to reliability factors. Further studies focusing on factors related to reliability are needed.

The Camberwell Assessment of Need (the CAN) is a widely used instrument in several countries to assess needs for the severely mentally ill. The instrument consists of ratings of needs made by patient and staff. This paper reports test-retest reliability for staff ratings in the Swedish version. Fifty-six patients, most of them with a diagnosis of schizophrenia, were interviewed by one person from the social services and by one from the psychiatric clinic. Afterwards the ratings were discussed and negotiated in order to arrive at one unanimous rating. The same procedure was replicated after 2-4 weeks. The intraclass correlation coefficient for the sum of needs was 0.93, and for the sum of unmet needs and met needs 0.80 for both. There were no means differences between the first and second rating. An analysis was also made of the test-retest scores of individual needs and subscales. The results in this study suggest that the summary scores of the CAN generally are reliable over time when using the method applied here. General conclusions about test-retest reliability for individual needs and subscales are more difficult to make and demand larger samples.

It seems urgent to have a gender perspective in a needs-led mental healthcare service.

No abstract

A process of deinstitutionalization and a series of mental health care reforms targeting severely mentally ill persons have taken place worldwide. The objective of this study was to follow-up the volume of psychiatric care after the 1995 Swedish reform and to study if the intended efforts of the reform were fulfilled. In a municipality, during the time-period 1994-2003, the development of number of days of inpatient care, inpatient care episodes, visits to outpatient facilities and the number of unique patients were studied using case registers. The number of persons staying in group homes and nursery homes was also studied. The number of days of inpatient care for persons given a diagnosis of schizophrenia was drastically reduced, but this reduction was quantitatively substituted by the persons staying in different kind of group homes. The implementation of new psychiatric field teams directed towards persons with psychosis and new social service field teams targeting this same group were reflected in the registers. Data supported that the intended efforts of the mental health care reform were in fact carried out, but the prioritizing of the target group of the reform may have influenced the care of persons with other kinds of psychiatric problems negatively.