The Nordic Study on schizophrenic patients living in the community. Subjective needs and perceived help

Abstract

In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% ('telephone') to 84.0% ('psychotic symptoms'). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% ('telephone') and 80.6% ('food'). The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs. In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received. In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs. It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.

Components Associated with Adequacy of Help for Consumers with Severe Mental Disorders

“…Previous studies also found a low rate of adequacy in these particular domains (Hansson et al 1995;Middleboe et al 2001;Simons and Petch 2002). In our study, these needs are considered more unmet by consumers than by staff.…”

“…In our study, accommodations ranked first and second in importance by consumers and staff, respectively. Generally, this domain is ranked between tenth and twelfth (Fleury et al 2008;Hansson et al 1995;Middleboe et al 2001;Ochoa et al 2003;Simons and Petch 2002). Food, money and looking after the home are also more highly rated by consumers and staff in our study.…”

“…Few studies present results of other CAN sections dealing with help provided by services or relatives, need for help, and adequacy and consumer satisfaction (Hansson et al 1995;Middleboe et al 2001;Simons and Petch 2002). Some studies have compared help provided by local services and relatives, respectively (Fleury et al 2008;Ochoa et al 2003).…”

“…The use of only the short version is justified by the fact that a serious problem in a specific domain is interpreted as an unmet need (Phelan et al 1995). The number of met needs is then viewed as a good indicator of adequacy of help and satisfaction (Middleboe et al 2001). Therefore, no study has attempted to identify variables associated with adequacy of help.…”

Improving community health networks for people with severe mental illness: a case study investigation

“…This finding has been replicated in studies which had also reported a lack of social support, and unmet needs around social interaction and community belonging. 82,83 Studies which examined composition of social networks of individuals with psychosis had found them to contain fewer friends 46 and more service practitioners 84 than the general population, and the onset of psychosis can involve changes in social networks and the loss of friends. 85 It is the multifaceted and dynamic nature of social networks that this study explores, looking beneath a map of connections to understand the negotiated meaning, sets of choices, capacity for growth and qualities such as reciprocity.…”