BMJ 1996;312:1582-1586 (22 June)

General practice

Needs for care from a demand led community psychiatric service: a study of patients with major mental illness

Valerie Murray, research registrar,a Helen W Walker, research nurse,a Caroline Mitchell, consultant psychiatrist,a Anthony J Pelosi, consultant psychiatrist a

a Lanarkshire Healthcare NHS Trust, Hairmyres Hospital, East Kilbride G75 8RG

Correspondence to: Dr Pelosi.

Abstract

Objective: To measure needs for care of patients aged 18-65 years with major mental illness.
Design: Identification of everyone in one area seen 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: Hamilton, a socially deprived district of Scotland.
Subjects: 71 subjects were interviewed from the original sample of 263 patients.
Main outcome measures: "Cardinal problems" in seven clinical and eight social areas of functioning; these are defined as problems requiring action. "Needs"--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 social needs. Skills to deal with all but seven needs in the sample were available at the time of investigation. Patients not being seen by the community mental health team were similar in severity and levels of need to those who were on the community team's caseload. Care was unequivocally and severely inadequate for four patients. Shortcomings in service delivery usually arose from failure to monitor some patients at home. Problems were not due to shortage of acute psychiatric beds nor the absence of an elaborate assertive community care team.
Conclusions: Systematic assessment of needs with research instruments can give valuable insights into the successes and failures of community care of people 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 less severe disorders.

Key messages

  • A representative group of people with previously identified major mental illnesses showed high levels of distress and disability and most had one or more clinical or social needs

  • Patients receiving rudimentary or no care from the psychiatric services had, on average, similar levels of disability and need to those receiving regular input from a multidisciplinary community mental health team

  • Routine individual assessment of needs could deal with many of the concerns about the welfare of people with major mental illness who live in the community

  • No matter what monitoring mechanisms are in place it will never be possible to prevent a small number of seriously mentally ill people from avoiding all medical and social care


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