13 - The unmet needs of people suffering from schizophrenia

Summary

Increasing importance is being attached to the needs of those who suffer from schizophrenia. This new orientation marks a wider public mood that emphasizes the active role of the recipients of health services as consumers, and also raises a series of important consequent questions. How can needs be defined and by whom? How can they be measured and compared? What importance should be given to both met and unmet needs when assessing individual patients, and when planning and evaluating the mental health services as a whole? How should the needs of those suffering from schizophrenia be prioritized in relation to the needs of other diagnostic groups?

These questions form the context of this chapter. Here we examine in turn these two levels of need: individual and service. In the first section of the chapter, we shall describe three methods of assessing individual patient's needs (the Needs for Care Assessment, the Camberwell Assessment of Need, and the Cardinal Needs Schedule), and we shall give details of one study in South London which has used this approach to assess unmet individual needs. In the second section we turn to service-level (or population) needs, and describe four methods appropriate to this level. We then offer one example to highlight this method of needs assessment which draws upon a recent detailed review of the needs for mental health services throughout London. Finally we return to one of the most central and intriguing issues: who should define these needs?