CAN: Camberwell Assessment of Need By Mike Slade, GrahamThornicroft, Linda Loftus, Michael Phelan & Til Wykes. London: Gaskell. 1999. 144 pp. £45.00 (pb). ISBN 1-901242-25-0

This book is intended for people who are using or are considering using the Camberwell Assessment of Need (CAN). The CAN was developed by the Section of Community Psychiatry (PRiSM) at the Institute of Psychiatry. It is described as “a tool for assessing the needs of people with severe and enduring mental illness”, covering both health and social needs. It was developed for use by mental health care professionals, service users or other non-mental health professionals, and has clinical and research versions.

In the UK, a needs-led approach is a central theme in the individual care of those with severe mental illness (National Health Service and Community Care Act 1990), and this has been encouraged by the introduction of the Care Programme Approach. In this book the authors discuss the concept of ‘need’ and how it can be defined and assessed. They emphasise that need is a subjective notion and that the judgement of its presence or absence depends on the viewpoint being taken. They argue that with the use of a tool such as the CAN the differences in perception of need between users of mental health services and the involved professionals can be identified, and then negotiation can take place to agree a care plan. The authors also recommend the CAN for use in assessing population need. They argue that if services are to be appropriately developed, an agreed method for assessing need is required, and suggest that the CAN is one of only four instruments available for needs assessment. Furthermore, it is the only one that is suitable for use by those without extensive experience.

There are dissenting voices. Priebe et al (1999) question the entire concept of need. They cite the subjective nature of needs and the low-to-moderate congruence between needs assessment of patients, keyworkers and others. They argue that the term ‘need’ implies that there is a specific effective intervention available to meet it, greatly oversimplifying the complex process of decision-making.

This book includes a description of the development of the CAN and a paper describing its reliability and validity. The authors emphasise that needs assessment should be part of routine clinical practice and that the CAN is brief to administer and can be used by a wide range of professionals without formal training. Indeed, this book gives all the information needed to use the CAN in any setting, with separate manuals for each of the three different versions (research, clinical and short). They also included a training package and copies of the three versions for photocopying. The training package and manuals are brief, pragmatic and easy to follow.

In summary, the weakness of the book may lie in the basic concept of need, rather than the text itself. However, if you accept that needs assessment is a useful concept and have decided to measure need, this is the book to purchase.